Psychiatric Assessment and Diagnosis — MCQs

A 25-year-old housewife presented to the psychiatry outpatient department complaining that her nose was longer than usual. She felt that her husband did not like her because of this perceived deformity and had developed a relationship with the neighboring girl. Furthermore, she complained that people made fun of her. It was not possible to convince her that there was no deformity. What do her symptoms suggest?

Q213Easy

What is the term for a persistent belief in something that is not a fact?

Q214Easy

Stereotypic movements are

Q215Medium

Which of the following is the odd one out?

Q216Medium

Which of the following is NOT true about dementia?

Q217Easy

False perception without any external stimulus is:

Q218Easy

Delusions are seen in all of the following conditions, except?

Q219Easy

Term partialism refers to fetishes involving which of the following?

Q220Medium

A 45-year-old male presents with a 7-day history of continuous, non-progressive headache. He believes he has a brain tumor and has consulted multiple neurologists, with all investigations being within normal limits. He requests further investigations to confirm the presence of a brain tumor. Psychiatric evaluation suggests the condition is present despite normal investigations. What is the most probable diagnosis?

Psychiatric Assessment and Diagnosis Indian Medical PG Practice Questions and MCQs

Question 211: What is fetishism?

A. Transvestism
B. Bestiality
C. Buccal coitus
D. Sexual perversion (Correct Answer)

Explanation: **Explanation:** **Fetishism** is a type of **Paraphilic Disorder** (historically and broadly referred to as **Sexual Perversion**). It involves the use of non-living objects (e.g., shoes, undergarments, leather) or a highly specific focus on a non-genital body part (e.g., feet) as the primary or exclusive source of sexual arousal and gratification. In psychiatric classification (DSM-5/ICD-11), it is considered a disorder when it causes significant distress or functional impairment. **Analysis of Options:** * **Option D (Correct):** Fetishism falls under the umbrella of sexual perversions (paraphilias), which are characterized by abnormal sexual desires or behaviors directed toward unconventional objects, situations, or individuals. * **Option A:** **Transvestism** (Transvestic Disorder) involves sexual arousal from cross-dressing. While it is also a paraphilia, it is a distinct entity from fetishism, though "fetishistic transvestism" is a specific subtype. * **Option B:** **Bestiality** (Zoophilia) involves sexual attraction to or acts with animals. It is a separate category of paraphilia. * **Option C:** **Buccal coitus** refers to oral sex. This is considered a variation of normal sexual behavior and is not classified as a psychiatric perversion or paraphilia. **High-Yield Clinical Pearls for NEET-PG:** * **Gender Prevalence:** Fetishism is diagnosed almost exclusively in **males**. * **Common Fetishes:** Inanimate objects (clothing, footwear) or specific body parts (podophilia/foot fetish). * **Diagnosis:** Symptoms must be present for at least **6 months** for a formal diagnosis of Fetishistic Disorder. * **Treatment:** Behavioral therapy (Aversion therapy, Covert sensitization) and SSRIs or anti-androgens to reduce compulsive sexual drive are the mainstays of management.

Question 212: A 25-year-old housewife presented to the psychiatry outpatient department complaining that her nose was longer than usual. She felt that her husband did not like her because of this perceived deformity and had developed a relationship with the neighboring girl. Furthermore, she complained that people made fun of her. It was not possible to convince her that there was no deformity. What do her symptoms suggest?

A. Delusion (Correct Answer)
B. Depression
C. Hallucination
D. Depersonalization

Explanation: ### Explanation The patient’s presentation is a classic example of a **Delusion**. A delusion is defined as a fixed, false belief that is firmly held despite incontrovertible evidence to the contrary and is out of keeping with the patient’s social, cultural, and educational background. In this case, the patient has a false belief regarding a physical deformity (her nose being "longer than usual"). This belief is **fixed** (she cannot be convinced otherwise) and has led to **secondary delusions** of infidelity (husband’s affair) and persecution (people making fun of her). This specific presentation is often seen in **Delusional Disorder (Somatic Type)**. #### Why other options are incorrect: * **Depression:** While patients with depression may have low self-esteem or body image issues, the core symptoms (low mood, anhedonia, fatigue) are absent here. The primary pathology is the fixed belief, not a mood disturbance. * **Hallucination:** These are sensory perceptions in the absence of an external stimulus (e.g., hearing voices). The patient is not "seeing" a nose that isn't there; she is "interpreting" her existing nose incorrectly. * **Depersonalization:** This is a feeling of detachment from oneself, as if one is an outside observer of their body or mental processes. It does not involve fixed false beliefs about physical appearance. #### NEET-PG Clinical Pearls: * **Delusional Disorder vs. Body Dysmorphic Disorder (BDD):** In BDD, the patient is preoccupied with a perceived flaw but usually maintains some insight or has "overvalued ideas." Once the belief becomes **fixed and unshakeable**, it is classified as a Somatic Delusion. * **Monodelusional Psychosis:** When a patient has a single, circumscribed delusional system (like the nose deformity) while the rest of their personality remains intact, it is termed Monodelusional Psychosis (or Paranoia). * **Key Feature:** The hallmark of a delusion is the **lack of insight** and the inability to be corrected by logic.

Question 213: What is the term for a persistent belief in something that is not a fact?

A. Illusion
B. Hallucination
C. Delusion (Correct Answer)
D. Delirium

Explanation: **Explanation:** The correct answer is **Delusion**. In psychiatry, a delusion is defined as a **fixed, false belief** that is firmly held despite incontrovertible evidence to the contrary and is not consistent with the patient’s educational, cultural, or social background. It is a disorder of the **content of thought**. **Analysis of Options:** * **Delusion (Correct):** It is a subjective belief. Key characteristics include being unshakable, false, and out of keeping with the individual's socio-cultural context. * **Illusion:** This is a disorder of perception involving the **misinterpretation of a real external stimulus** (e.g., mistaking a rope for a snake in the dark). * **Hallucination:** This is a **perception in the absence of an external stimulus**. The person sees, hears, or feels something that is not there, but the experience has the vividness and impact of a real perception. * **Delirium:** This is an acute, transient, and reversible state of **confusion** characterized by clouded consciousness, disorientation, and fluctuating levels of attention. It is an organic mental disorder, not a specific term for a belief. **High-Yield Clinical Pearls for NEET-PG:** * **Overvalued Idea:** A solitary, abnormal belief that is neither delusional nor obsessive but is preoccupied with by the patient (e.g., hypochondriasis). Unlike a delusion, it is not necessarily "fixed" or "false." * **Bizarre vs. Non-Bizarre:** Delusions are "bizarre" if they are physically impossible (e.g., aliens replacing organs without scars) and "non-bizarre" if they are plausible but untrue (e.g., being followed by the police). * **Primary Delusion (Autochthonous):** Arises suddenly "out of the blue" without a preceding mental event; highly characteristic of Schizophrenia.

Question 214: Stereotypic movements are

A. Sustained posture against gravity
B. Passive inducible movements
C. Repetitive, spontaneous, nonfunctional movements (Correct Answer)
D. Resistance to passive movements

Explanation: **Explanation:** **Stereotypic movements** (Stereotypies) are defined as repetitive, rhythmic, fixed, and nonfunctional motor behaviors. These movements are typically spontaneous and often occur in a predictable pattern (e.g., hand waving, body rocking, or head banging). They are commonly associated with Autism Spectrum Disorder (ASD), Intellectual Disability, and certain sensory deprivation states. Unlike tics, they are more rhythmic and can often be stopped by distraction. **Analysis of Incorrect Options:** * **A. Sustained posture against gravity:** This describes **Catalepsy**. It is a state of muscular rigidity where a patient maintains a fixed posture for a long duration, often seen in catatonic schizophrenia. * **B. Passive inducible movements:** This refers to **Mannerisms**. While often confused with stereotypies, mannerisms are goal-directed or functional movements (like a salute or a specific way of waving) that are performed in an odd, exaggerated, or stilted manner. * **C. Resistance to passive movements:** This describes **Gegenhalten** (paratonia) or **Negativism**. In catatonia, if the resistance is equal to the force applied, it is termed "rigid resistance"; if the patient resists all instructions or attempts to be moved, it is "negativism." **High-Yield Clinical Pearls for NEET-PG:** * **Stereotypy vs. Tic:** Stereotypies have an earlier age of onset (usually <3 years), are rhythmic, and lack the premonitory urge associated with tics. * **Waxy Flexibility (Cerea Flexibilitas):** A specific type of catatonic behavior where the patient offers initial resistance to moving a joint, but then allows the limb to be placed in a new position, which is then maintained (like bending a wax candle). * **Echopraxia:** The involuntary imitation of another person's movements, another key feature of catatonia.

Question 215: Which of the following is the odd one out?

A. Dhat syndrome
B. Run amok
C. Koro
D. Briquet syndrome (Correct Answer)

Explanation: ### Explanation The correct answer is **Briquet syndrome** because it is a formal psychiatric diagnosis recognized in historical classifications (now known as **Somatic Symptom Disorder**), whereas the other three options are **Culture-Bound Syndromes**. #### 1. Why Briquet Syndrome is the Odd One Out **Briquet syndrome** (named after Paul Briquet) is a chronic, poly-symptomatic disorder characterized by multiple recurrent somatic complaints (pain, GI, sexual, and neurological symptoms) that cannot be fully explained by a physical examination. In modern nomenclature (DSM-5), it is classified under **Somatic Symptom Disorder**. Unlike the other options, it is not restricted to a specific geographic or cultural group. #### 2. Analysis of Incorrect Options (Culture-Bound Syndromes) * **Dhat Syndrome:** Predominantly seen in the **Indian subcontinent**. It involves clinical distress related to the perceived loss of "dhat" (semen) through urine or nocturnal emissions, often associated with anxiety and fatigue. * **Run Amok:** Originally described in **Malaysia/Southeast Asia**. It involves a sudden episode of indiscriminate homicidal or destructive behavior, followed by exhaustion and amnesia. * **Koro:** Primarily seen in **South China and Southeast Asia**. It is an episode of sudden, intense anxiety that the penis (or breasts/vulva in females) is shrinking or retracting into the abdomen, potentially causing death. #### Clinical Pearls for NEET-PG * **Latah:** A Southeast Asian syndrome involving hypersensitivity to sudden fright, often with echolalia or echopraxia. * **Pibloktoq (Arctic Hysteria):** Seen in Inuit communities; involves extreme excitement followed by seizures or coma. * **Windigo:** Seen in Algonquin Indians; the fear of being transformed into a cannibalistic monster. * **Key Distinction:** Culture-bound syndromes are "folk illnesses" specific to certain societies, whereas Briquet syndrome is a universal psychiatric entity.

Question 216: Which of the following is NOT true about dementia?

A. Often irreversible
B. Hallucinations are not common
C. Clouding of consciousness is common (Correct Answer)
D. Nootropics have limited role

Explanation: **Explanation:** The core of this question lies in the clinical differentiation between **Dementia** (Major Neurocognitive Disorder) and **Delirium**. **Why Option C is the correct answer (False statement):** In Dementia, the **sensorium remains clear** and the level of consciousness is typically unaffected until the very terminal stages. **Clouding of consciousness** is the hallmark feature of **Delirium**. If a patient presents with fluctuating levels of awareness and disorientation, the diagnosis shifts toward Delirium rather than primary Dementia. **Analysis of other options:** * **A. Often irreversible:** Most common causes of dementia (Alzheimer’s, Vascular, Frontotemporal) are progressive and irreversible. While "reversible dementias" (e.g., Vitamin B12 deficiency, Hypothyroidism) exist, they represent a small minority. * **B. Hallucinations are not common:** In the early to middle stages of Alzheimer’s (the most common dementia), hallucinations are infrequent. While they are a core feature of *Lewy Body Dementia*, they are not a standard early symptom of dementia as a general category. * **D. Nootropics have limited role:** Drugs like Donepezil or Memantine (often categorized under nootropics/cognitive enhancers) only provide symptomatic relief and slow the rate of decline; they do not cure the underlying pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Dementia vs. Delirium:** Dementia is chronic, progressive, and has a clear sensorium. Delirium is acute, fluctuating, and has a clouded sensorium. * **Memory:** In dementia, **recent memory** is lost first (Anterograde amnesia), while remote memory is preserved until late. * **Pseudodementia:** This refers to **Depression** in the elderly mimicking dementia. Key differentiator: In pseudodementia, the patient often complains of memory loss ("I don't know"), whereas in true dementia, the patient often tries to hide or minimize deficits (Confabulation).

Question 217: False perception without any external stimulus is:

A. Illusion
B. Hallucination (Correct Answer)
C. Delirium
D. Delusion

Explanation: ### Explanation **Correct Answer: B. Hallucination** **Why it is correct:** A **hallucination** is defined as a sensory perception in the absence of an external stimulus. It is a "perception without an object." Hallucinations occur in the external space (unlike imagery) and possess the same vividness and quality as a real perception. They can occur in any sensory modality (auditory, visual, olfactory, gustatory, or tactile). **Why the other options are incorrect:** * **A. Illusion:** This is a **misinterpretation** of a real external stimulus (e.g., mistaking a rope for a snake in the dark). Unlike hallucinations, an external object is present. * **C. Delirium:** This is an acute, reversible state of confusion characterized by a clouding of consciousness, disorientation, and fluctuating attention. While hallucinations (especially visual) can occur *during* delirium, the term itself refers to the global cognitive syndrome, not the specific perceptual error. * **D. Delusion:** This is a disorder of **thought content**, not perception. It is defined as a fixed, false belief that is out of keeping with the patient’s social, cultural, and educational background and is held with absolute conviction despite logical evidence to the contrary. **High-Yield Clinical Pearls for NEET-PG:** * **Most common hallucination in Schizophrenia:** Auditory (specifically third-person "running commentary"). * **Most common hallucination in Organic Brain Syndromes (e.g., Delirium):** Visual. * **Hypnagogic vs. Hypnopompic:** Hallucinations occurring while falling asleep (Hypna**g**ogic = **G**oing to sleep) vs. waking up (Hypno**p**ompic = **P**op out of bed). * **Formication:** A tactile hallucination feeling like insects crawling under the skin, commonly seen in cocaine withdrawal ("Cocaine bugs") or alcohol withdrawal.

Question 218: Delusions are seen in all of the following conditions, except?

A. Schizophrenia
B. Depression
C. Dementia
D. Conversion disorder (Correct Answer)

Explanation: **Explanation:** The core of this question lies in distinguishing between **Psychotic Disorders** (characterized by a loss of reality testing) and **Somatoform/Dissociative Disorders**. **Why Conversion Disorder is the correct answer:** Conversion Disorder (Functional Neurological Symptom Disorder) is a condition where patients present with neurological symptoms (like paralysis, blindness, or seizures) that cannot be explained by a neurological disease. These symptoms are usually triggered by psychological stress. Crucially, Conversion Disorder involves **physical symptoms**, not disturbances in thought content. **Delusions**, which are fixed, false beliefs resistant to reasoning, are a hallmark of psychosis and are not a feature of Conversion Disorder. **Analysis of Incorrect Options:** * **Schizophrenia:** Delusions are a primary diagnostic criterion (Schneiderian First Rank Symptoms). Patients often exhibit persecutory, referential, or bizarre delusions. * **Depression:** In "Psychotic Depression," patients may experience delusions that are typically **mood-congruent**, such as delusions of guilt, poverty, or nihilism (Cotard’s syndrome). * **Dementia:** Psychotic symptoms are common in the behavioral and psychological symptoms of dementia (BPSD). For example, patients with Alzheimer’s often develop delusions of theft or infidelity. **Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic (though not pathognomonic) sign in Conversion Disorder where the patient shows a surprising lack of concern regarding their severe physical disability. * **Secondary Gain:** Conversion symptoms often provide an unconscious "gain" (e.g., avoiding a stressful situation). * **Delusion Definition:** Always remember the "3 Fs"—**F**ixed, **F**alse belief, held despite contrary evidence, and not in keeping with the patient's social/cultural **F**ramework.

Question 219: Term partialism refers to fetishes involving which of the following?

A. Nonsexual body part (Correct Answer)
B. Specific clothing
C. Specific type of food
D. Nonsexual behavior

Explanation: **Explanation:** **Partialism** is a specific form of paraphilic disorder where sexual interest and arousal are focused exclusively on a **nonsexual body part** (e.g., feet, hands, hair, or navel) rather than the genitals. While the DSM-5 classifies partialism under the umbrella of **Fetishistic Disorder**, it is distinguished by the fact that the fetish object is a part of the human body rather than an inanimate object. **Analysis of Options:** * **Option A (Correct):** Partialism specifically refers to the sexualization of body parts that are not traditionally considered erogenous or primary/secondary sexual organs. * **Option B (Incorrect):** Interest in specific clothing (e.g., shoes, stockings, or leather) is defined as **Fetishism** involving inanimate objects. If the clothing belongs to the opposite sex and is worn for arousal, it is termed **Transvestic Disorder**. * **Option C (Incorrect):** Sexual arousal involving food is known as **Sitiaurism** or "food play" and is not classified as partialism. * **Option D (Incorrect):** Focus on nonsexual behaviors or specific scenarios (e.g., watching others, inflicting pain) falls under other paraphilias like **Voyeurism** or **Sexual Sadism**, rather than partialism. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, Fetishistic Disorder is diagnosed only if the behavior causes clinically significant distress or impairment for at least **6 months**. * **Commonest Site:** The **foot** (podophilia) is the most common body part involved in partialism. * **Gender Distribution:** These disorders are diagnosed almost exclusively in **males**. * **Treatment:** Cognitive Behavioral Therapy (CBT) and SSRIs are first-line; Anti-androgens (e.g., Medroxyprogesterone) are used in severe cases to reduce libido.

Question 220: A 45-year-old male presents with a 7-day history of continuous, non-progressive headache. He believes he has a brain tumor and has consulted multiple neurologists, with all investigations being within normal limits. He requests further investigations to confirm the presence of a brain tumor. Psychiatric evaluation suggests the condition is present despite normal investigations. What is the most probable diagnosis?

A. Hypochondriasis (Correct Answer)
B. Somatization disorder
C. Somatoform pain disorder
D. Conversion disorder

Explanation: **Explanation:** The core feature of this case is the **preoccupation with the fear or idea of having a serious disease** (brain tumor) based on a misinterpretation of bodily symptoms (headache), which persists despite medical reassurance and normal investigations. **1. Why Hypochondriasis is correct:** In **Hypochondriasis** (now termed Illness Anxiety Disorder in DSM-5), the patient’s primary concern is the *meaning* of the symptom rather than the symptom itself. The patient is convinced they have a specific, serious underlying pathology. The duration (though typically 6 months for a formal diagnosis, the clinical presentation here is classic) and the "doctor-shopping" behavior are hallmark features. **2. Why other options are incorrect:** * **Somatization Disorder:** Characterized by multiple, recurrent, and frequently changing physical symptoms (involving gastrointestinal, sexual, and neurological systems) rather than a preoccupation with a single serious disease. * **Somatoform Pain Disorder:** The primary complaint is persistent, severe, and distressing pain that cannot be fully explained by a physiological process. The focus is on the *pain* itself, not a specific underlying diagnosis like a tumor. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Involves a loss or change in motor or sensory function (e.g., paralysis, blindness, seizures) that suggests a neurological condition but is triggered by psychological conflict or stress. **Clinical Pearls for NEET-PG:** * **Hypochondriasis:** Focus is on the **Disease** (Fear of having a tumor). * **Somatization:** Focus is on the **Symptoms** (Multiple vague complaints). * **Conversion:** Focus is on **Function** (Loss of voluntary motor/sensory power). * **Factitious Disorder:** Symptoms are intentionally produced to assume the "sick role" (internal gain). * **Malingering:** Symptoms are faked for external gain (e.g., money, avoiding work).

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