Psychiatric Assessment and Diagnosis — MCQs
On this page
A 50-year-old male presents to his physician every month complaining about headaches, suspecting a brain tumor. Despite a normal MRI scan, he remains unconvinced that the diagnosis has been ruled out. The physician believes the patient misinterprets bodily sensations and is overly concerned about his health. What is the likely diagnosis?
A female presented with a history of episodes of altered sensorium, involuntary movements, memory deficits, and headache for the last 6 months. Four episodes occurred during the day and two during sleep. She has been married for 1 year. What is the most likely diagnosis?
Disturbance of affect is not seen in which of the following?
A 23-year-old man was found roaming aimlessly near a railway station. When enquired about his whereabouts, he appeared confused and was unable to state his name and address. He could not recall how he reached the station or anything about his past. His belongings included an AADHAR CARD with an address from Srinagar, Jammu & Kashmir. His family reported that his father had died the previous day, after which he went missing. What is the likely diagnosis?
A 52-year-old man with no history of psychiatric illness presents with recent onset of disorientation, fluctuating mental status, abnormal autonomic signs, tremor, and visual hallucinations described as 'little snakes' in his house. He has no known history of substance abuse. What is the most likely diagnosis?
What is the current term for mental retardation as per the American Association on Intellectual and Developmental Disabilities?
A person is referred to you by the court due to a discrepancy between their reported history and examination findings. Which of the following conditions should you be aware of in this situation?
What is an illusion?
What is perseveration?
Akinesia and mutism are characteristic features of which of the following states?
Psychiatric Assessment and Diagnosis Indian Medical PG Practice Questions and MCQs
Question 31: A 50-year-old male presents to his physician every month complaining about headaches, suspecting a brain tumor. Despite a normal MRI scan, he remains unconvinced that the diagnosis has been ruled out. The physician believes the patient misinterprets bodily sensations and is overly concerned about his health. What is the likely diagnosis?
- A. Pituitary Tumour
- B. Hypochondriasis (Correct Answer)
- C. Somatisation Disorder
- D. Capgras Syndrome
Explanation: ### Explanation **Correct Answer: B. Hypochondriasis** **1. Why Hypochondriasis is correct:** The patient’s presentation aligns with the classic definition of **Hypochondriasis** (now classified as *Illness Anxiety Disorder* in DSM-5). The core feature is a **preoccupation with the fear of having a serious disease** based on a misinterpretation of bodily symptoms. Key diagnostic markers present in this case include: * Persistence of symptoms for at least 6 months. * Persistent refusal to accept medical reassurance despite negative investigations (the normal MRI). * The belief is held with less than delusional intensity (the patient is "unconvinced" rather than having a fixed, unshakeable false belief). **2. Why the other options are incorrect:** * **A. Pituitary Tumor:** This is a physical diagnosis. The normal MRI scan effectively rules out structural brain pathology. * **C. Somatisation Disorder:** While both involve physical symptoms, Somatisation Disorder (Somatic Symptom Disorder) focuses on the **distress caused by the symptoms themselves** (e.g., pain, GI issues) rather than the *fear of an underlying diagnosis*. It typically involves multiple, vague symptoms across different organ systems starting before age 30. * **D. Capgras Syndrome:** This is a delusional misidentification syndrome where a patient believes a close relative or friend has been replaced by an identical-looking impostor. It has no relation to health anxiety. **3. High-Yield Clinical Pearls for NEET-PG:** * **Hypochondriasis vs. Delusion:** In Hypochondriasis, the patient can acknowledge the possibility that their fear is unfounded (poor insight); in a **Somatic Delusion**, the conviction is absolute and unshakeable. * **Doctor Shopping:** These patients frequently engage in "doctor shopping" and undergo repeated, unnecessary investigations. * **Treatment:** The treatment of choice is **Cognitive Behavioral Therapy (CBT)**. SSRIs are useful if there is comorbid anxiety or depression.
Question 32: A female presented with a history of episodes of altered sensorium, involuntary movements, memory deficits, and headache for the last 6 months. Four episodes occurred during the day and two during sleep. She has been married for 1 year. What is the most likely diagnosis?
- A. Epilepsy (Correct Answer)
- B. Somatization disorder
- C. Somatoform disorder
- D. Hypochondriasis
Explanation: **Explanation:** The clinical presentation of altered sensorium, involuntary movements, and memory deficits suggests a neurological or psychiatric origin. The key diagnostic feature in this case is the **occurrence of episodes during sleep**. **1. Why Epilepsy is the Correct Answer:** Epilepsy is characterized by recurrent, unprovoked seizures. While "Dissociative Convulsions" (formerly Hysterical Seizures) can mimic epilepsy, they are almost exclusively restricted to wakefulness and usually occur in the presence of an audience. The fact that this patient experienced **two episodes during sleep** is a strong clinical indicator of organic epilepsy. Nocturnal episodes, tongue biting (lateral), and post-ictal confusion are classic "red flags" that point away from a psychiatric diagnosis and toward a seizure disorder. **2. Why Incorrect Options are Wrong:** * **Somatization Disorder:** Now classified under Somatic Symptom Disorder (DSM-5), this involves multiple, persistent physical complaints (pain, GI, sexual) across different organ systems over years. While it can include pseudo-neurological symptoms, it does not explain nocturnal episodes. * **Somatoform Disorder:** This is a broad category where physical symptoms suggest a medical condition but are not fully explained by one. Dissociative (Conversion) disorder falls under this, but again, symptoms do not occur during sleep. * **Hypochondriasis (Illness Anxiety Disorder):** This involves a preoccupation with having a serious illness based on a misinterpretation of bodily symptoms, rather than the presence of objective involuntary movements or altered sensorium. **Clinical Pearls for NEET-PG:** * **Gold Standard Rule:** Seizures occurring during sleep are **organic (Epilepsy)** until proven otherwise. * **Prolactin Levels:** Serum prolactin is often elevated 15–30 minutes after a true generalized tonic-clonic seizure, helping differentiate it from dissociative convulsions. * **EEG:** While a normal interictal EEG doesn't rule out epilepsy, Video-EEG monitoring is the gold standard for differentiating epilepsy from non-epileptic attack disorder (NEAD).
Question 33: Disturbance of affect is not seen in which of the following?
- A. Drowsiness
- B. Obsessions (Correct Answer)
- C. Hallucinations
- D. Delusions
Explanation: **Explanation:** The core of this question lies in distinguishing between **disorders of thought content** and **disorders of affect (emotion)**. **Why "Obsessions" is the correct answer:** Obsessions are defined as persistent, recurrent, and intrusive thoughts, impulses, or images that are experienced as ego-dystonic. They are primarily a **disorder of the content of thought**, not a primary disturbance of affect. While obsessions often *cause* secondary anxiety or distress, the primary psychopathological process is cognitive/thought-based rather than emotional. **Analysis of Incorrect Options:** * **Drowsiness:** This is a state of impaired consciousness. In organic brain syndromes or altered levels of consciousness, the patient’s emotional responsiveness (affect) is typically blunted, slowed, or inappropriate to the environment. * **Hallucinations:** These are disorders of perception. However, they are frequently accompanied by a corresponding affect (e.g., a patient hearing threatening voices will exhibit an affect of intense fear or agitation). * **Delusions:** These are fixed, false beliefs (disorder of thought content). Like hallucinations, they are strongly linked to affect; for example, a patient with persecutory delusions will manifest a suspicious or guarded affect, while one with grandiose delusions will show an elated or expansive affect. **High-Yield Clinical Pearls for NEET-PG:** * **Affect vs. Mood:** Affect is the *external, cross-sectional* expression of emotion (objective), while Mood is the *pervasive, sustained* internal emotional state (subjective). * **Obsessions vs. Delusions:** Obsessions are recognized by the patient as their own thoughts and are resisted (ego-dystonic), whereas delusions are firmly believed and usually not resisted (ego-syntonic). * **Components of Mental Status Examination (MSE):** Always categorize symptoms into Appearance, Speech, Mood/Affect, Thought (Stream, Form, Content), Perception, and Cognition. Obsessions and Delusions both fall under **Thought Content**.
Question 34: A 23-year-old man was found roaming aimlessly near a railway station. When enquired about his whereabouts, he appeared confused and was unable to state his name and address. He could not recall how he reached the station or anything about his past. His belongings included an AADHAR CARD with an address from Srinagar, Jammu & Kashmir. His family reported that his father had died the previous day, after which he went missing. What is the likely diagnosis?
- A. Dissociative fugue (Correct Answer)
- B. Dissociative identity disorder
- C. Post-traumatic stress disorder
- D. Depersonalization/derealization disorder
Explanation: ### Explanation **Correct Answer: A. Dissociative fugue** The clinical presentation is a classic case of **Dissociative Fugue**. This condition is characterized by sudden, unexpected travel away from home or one’s customary place of work, accompanied by an inability to recall one's past and confusion about personal identity (or the assumption of a new identity). **Key diagnostic features present in this case:** 1. **Sudden Travel:** The patient was found far from his home (Srinagar) at a railway station. 2. **Memory Loss:** He is unable to state his name or recall how he reached the station. 3. **Psychological Stressor:** The fugue state was triggered by a significant emotional trauma (the death of his father). --- ### Why the other options are incorrect: * **B. Dissociative Identity Disorder (DID):** Formerly known as Multiple Personality Disorder, it involves the presence of two or more distinct personality states that take control of behavior. There is no evidence of "alters" here. * **C. Post-traumatic Stress Disorder (PTSD):** While triggered by trauma, PTSD presents with intrusive symptoms (flashbacks, nightmares), avoidance, and hyperarousal. It does not typically involve a loss of identity or wandering. * **D. Depersonalization/Derealization Disorder:** This involves a persistent feeling of being detached from oneself (like being in a dream) or the environment. Memory and identity remain intact. --- ### High-Yield Clinical Pearls for NEET-PG: * **ICD-10 vs. DSM-5:** In **DSM-5**, Dissociative Fugue is no longer a separate diagnosis; it is now a **specifier** under **Dissociative Amnesia**. However, NEET-PG questions often follow ICD-10 or older clinical classifications where it remains a distinct entity. * **Nature of Travel:** The wandering in fugue is usually purposeful (though the patient appears confused when questioned) and can last from hours to months. * **Recovery:** Recovery is usually spontaneous and rapid, but the patient may have a persistent "amnestic gap" for the duration of the fugue episode itself.
Question 35: A 52-year-old man with no history of psychiatric illness presents with recent onset of disorientation, fluctuating mental status, abnormal autonomic signs, tremor, and visual hallucinations described as 'little snakes' in his house. He has no known history of substance abuse. What is the most likely diagnosis?
- A. Schizophrenia
- B. Dementia
- C. Delirium (Correct Answer)
- D. Depression with psychotic features
Explanation: ### Explanation **Correct Option: C. Delirium** The clinical presentation is a classic textbook case of **Delirium**. The diagnosis is based on the following key features: 1. **Acute Onset and Fluctuating Course:** Unlike chronic psychiatric conditions, delirium develops over hours to days and symptoms typically wax and wane throughout the day. 2. **Disorientation and Altered Consciousness:** This is the hallmark of delirium, distinguishing it from functional psychoses like schizophrenia. 3. **Visual Hallucinations:** While auditory hallucinations are common in schizophrenia, **visual hallucinations** (especially "Lilliputian" or small animal hallucinations like 'little snakes') are highly suggestive of an organic cause or delirium. 4. **Autonomic Instability and Tremors:** These signs point toward an underlying medical emergency or withdrawal state rather than a primary psychiatric disorder. --- ### Why Other Options are Incorrect: * **A. Schizophrenia:** Usually presents in early adulthood (late teens to 20s). It features a clear sensorium (the patient is oriented), and hallucinations are predominantly **auditory**. * **B. Dementia:** While it involves cognitive decline, the onset is **insidious (gradual)** and the level of consciousness remains stable until the very late stages. * **D. Depression with Psychotic Features:** This would present with a prominent low mood, psychomotor retardation, and "mood-congruent" delusions (e.g., guilt, poverty). It does not cause acute disorientation or autonomic signs. --- ### NEET-PG High-Yield Pearls: * **Hallucination Type:** Visual hallucinations = Organic cause (Delirium/Drugs); Auditory hallucinations = Functional cause (Schizophrenia). * **EEG Finding:** Delirium typically shows **generalized slowing** of posterior dominant rhythm (except in Delirium Tremens, which shows low-voltage fast activity). * **Sundowning:** The worsening of delirium symptoms in the evening or night. * **Management:** The primary goal is to treat the **underlying cause**. For symptomatic control of agitation, low-dose **Haloperidol** is the drug of choice.
Question 36: What is the current term for mental retardation as per the American Association on Intellectual and Developmental Disabilities?
- A. Feeble Mindedness
- B. Subnormal intelligence
- C. Intellectual disability (Correct Answer)
- D. Mentally unstable
Explanation: **Explanation:** The term **Intellectual Disability (ID)** has officially replaced "Mental Retardation" across all major diagnostic and professional systems, including the **AAIDD** (American Association on Intellectual and Developmental Disabilities), **DSM-5**, and **ICD-11**. This shift reflects a move away from stigmatizing language toward a more clinical and functional description of the condition. **Why the correct answer is right:** Intellectual disability is defined by deficits in both **intellectual functioning** (reasoning, problem-solving, planning) and **adaptive functioning** (failure to meet developmental and sociocultural standards for personal independence). The AAIDD emphasizes that the diagnosis is not based solely on an IQ score (typically <70) but also on the level of support required for daily living. **Analysis of incorrect options:** * **A. Feeble Mindedness:** This is an archaic, derogatory term used in the early 20th century that has no place in modern clinical practice. * **B. Subnormal intelligence:** While descriptive of a low IQ, it is a non-specific term and not a formal diagnostic category. * **D. Mentally unstable:** This is a colloquial term often used to describe mood swings or psychosis; it does not refer to neurodevelopmental deficits or cognitive impairment. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** Diagnosis requires onset during the **developmental period** (before age 18). * **Severity Levels:** In DSM-5, severity (Mild, Moderate, Severe, Profound) is determined by **adaptive functioning**, not IQ scores. * **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. * **IQ Ranges (Historical):** Mild (50-70), Moderate (35-49), Severe (20-34), Profound (<20).
Question 37: A person is referred to you by the court due to a discrepancy between their reported history and examination findings. Which of the following conditions should you be aware of in this situation?
- A. Malingering
- B. Factitious disorder (Correct Answer)
- C. Somatization syndrome
- D. Dissociative fugue
Explanation: **Explanation:** The core clinical feature described is a **discrepancy between subjective history and objective clinical findings**, particularly in a **legal or forensic context**. **1. Why Factitious Disorder is Correct:** In Factitious Disorder (formerly Munchausen syndrome), the patient intentionally produces, feigns, or exaggerates physical or psychological symptoms. The primary motivation is to assume the **"sick role"** rather than for external incentives. While the question mentions a court referral (which often hints at Malingering), the specific clinical hallmark of Factitious Disorder is the inconsistency between the elaborate history provided by the patient and the lack of corresponding physical or laboratory evidence. **2. Why the Other Options are Incorrect:** * **Malingering:** While Malingering also involves intentional feigning of symptoms, it is motivated by **external incentives** (e.g., avoiding jail, obtaining financial compensation). In many psychiatric textbooks and exams, if the focus is on the *clinical discrepancy* itself rather than the *goal*, Factitious Disorder is highlighted. (Note: In actual practice, court cases often involve Malingering, but for exam purposes, the "discrepancy" is a classic descriptor for Factitious Disorder). * **Somatization Syndrome:** Symptoms are **unintentional** and unconscious. The patient truly believes they are ill; there is no deliberate fabrication of history. * **Dissociative Fugue:** This involves sudden, unexpected travel away from home with an inability to recall one's past. It is an unconscious defense mechanism, not a deliberate discrepancy in reporting history. **High-Yield Clinical Pearls for NEET-PG:** * **Factitious Disorder:** Internal motivation (Sick role). No external gain. * **Malingering:** External motivation (Money, avoiding work/law). Not a psychiatric disorder (V-code in DSM-5). * **Ganser Syndrome:** A subtype of Factitious Disorder often seen in prisoners, characterized by "approximate answers" (e.g., 2+2=5). * **Clue:** If the patient has a "gridiron abdomen" (multiple surgical scars) and provides a dramatic but inconsistent history, always suspect Factitious Disorder.
Question 38: What is an illusion?
- A. Feeling of familiarity with an unfamiliar thing
- B. Altered perception of a real object (Correct Answer)
- C. Belief in something even though it is proved false
- D. Perception occurring without external stimulation
Explanation: **Explanation:** In psychiatry, an **illusion** is defined as a **misinterpretation of a real external sensory stimulus**. It occurs when a physical object exists in the environment, but the brain perceives it incorrectly (e.g., mistaking a rope for a snake in the dark). This is a disorder of **perception**. **Analysis of Options:** * **Option B (Correct):** An illusion is an altered perception of a real object. It is common in both normal individuals (due to fatigue or poor lighting) and in clinical conditions like Delirium. * **Option A (Incorrect):** This describes **Déjà vu**, a phenomenon of familiarity. Its opposite (feeling unfamiliar with a known object) is **Jamais vu**. These are disorders of memory/recognition. * **Option C (Incorrect):** This is the definition of a **Delusion**. A delusion is a disorder of **thought content**, characterized by a fixed, false belief that is out of keeping with the patient’s social and cultural background and persists despite evidence to the contrary. * **Option D (Incorrect):** This defines a **Hallucination**. Unlike an illusion, a hallucination is a perception in the **absence** of any external stimulus (e.g., hearing voices when no one is speaking). **NEET-PG High-Yield Pearls:** 1. **Illusion vs. Hallucination:** The presence of an external stimulus is the key differentiating factor. 2. **Pareidolia:** A type of illusion where vague stimuli (like clouds) are perceived as meaningful images (like faces). 3. **Clinical Significance:** While illusions can occur in healthy people, frequent illusions are a hallmark of **Delirium** (Organic Brain Syndrome). 4. **Formication:** A specific tactile hallucination (feeling of insects crawling on skin) common in Cocaine withdrawal and Delirium Tremens.
Question 39: What is perseveration?
- A. Repetition of an activity
- B. Repetition of a word or a phrase (Correct Answer)
- C. Inability to change the mental set in spite of a new stimulus
- D. Persistence of an uncomfortable posture for long periods
Explanation: **Explanation:** **Perseveration** is a formal thought disorder characterized by the persistent repetition of a specific response (such as a word, phrase, or gesture) to a new stimulus, even when it is no longer appropriate. In clinical practice, the patient may correctly answer the first question but continues to give the same answer to subsequent, different questions. It is most commonly associated with **Organic Brain Syndromes** (like Dementia or Delirium) and occasionally Schizophrenia. **Analysis of Options:** * **Option B (Correct):** The repetition of a word or phrase beyond the point of relevance is the classic linguistic manifestation of perseveration. * **Option A:** General repetition of an activity is a broad term. If the activity is purposeless and ritualistic, it may be a **stereotype** or a **compulsion**, rather than perseveration. * **Option C:** While "inability to change the mental set" is the *psychological mechanism* behind perseveration, the clinical definition used in psychiatric exams specifically refers to the observable output (the repetition of the response). * **Option D:** Persistence of an uncomfortable posture is known as **Catalepsy** (Waxy Flexibility), a hallmark feature of Catatonic Schizophrenia. **NEET-PG High-Yield Pearls:** * **Palilalia:** Repetition of one’s own words with increasing frequency. * **Echolalia:** Psychopathological repetition of words or phrases spoken by *another* person. * **Verbigeration (Word Salad):** Senseless repetition of specific words or phrases (often seen in Schizophrenia). * **Localization:** Perseveration is a sensitive sign of **Frontal Lobe** dysfunction.
Question 40: Akinesia and mutism are characteristic features of which of the following states?
- A. Coma
- B. Torpor
- C. Stupor (Correct Answer)
- D. Twilight state
Explanation: **Explanation:** **Stupor** is a state of impaired consciousness characterized by **akinesia** (lack of physical movement) and **mutism** (lack of speech), while the patient remains relatively aware of their surroundings. A key diagnostic feature is that the patient can be aroused only by vigorous or repeated painful stimuli. In psychiatry, this is most commonly seen in **Catatonic Stupor** (Schizophrenia) or **Depressive Stupor**. **Analysis of Options:** * **Coma (Option A):** This is a state of deep unconsciousness where the patient cannot be aroused even by painful stimuli. Unlike stupor, there is no psychological awareness or purposeful response. * **Torpor (Option B):** This refers to a state of mental and physical inactivity or sluggishness. While the patient is drowsy and lacks vigor, they are not completely akinetic or mute. * **Twilight State (Option D):** This is a condition of "clouding of consciousness" where the patient performs complex, often goal-directed actions (like walking or dressing) but has no subsequent memory of them. It is typically seen in epilepsy (ictal/post-ictal) or dissociation. **Clinical Pearls for NEET-PG:** * **Psychiatric Stupor vs. Organic Stupor:** In psychiatric (catatonic) stupor, the patient often maintains posture (waxy flexibility) and may have open eyes, whereas organic stupor often involves closed eyes and lack of postural maintenance. * **Management:** The drug of choice for Catatonic Stupor is **Lorazepam** (Lorazepam Challenge Test). If unresponsive, Electroconvulsive Therapy (ECT) is the most effective treatment. * **Differential:** Always rule out **Locked-in Syndrome**, where the patient is akinetic and mute but fully conscious and can communicate via vertical eye movements.
Practice by Chapter
Clinical Interview Techniques
Practice Questions
Mental Status Examination
Practice Questions
Diagnostic Formulation
Practice Questions
Rating Scales and Questionnaires
Practice Questions
Psychological Testing
Practice Questions
Neuropsychological Assessment
Practice Questions
Risk Assessment
Practice Questions
Laboratory Investigations in Psychiatry
Practice Questions
Neuroimaging in Clinical Assessment
Practice Questions
Cultural Considerations in Assessment
Practice Questions
Developmental Assessment
Practice Questions
Diagnostic Classification Systems
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free