Examination in Psychiatry

I and III years

July 2013

Please answer all the Following Questions:

1-The following features are commonly encountered in patients with delirium

tremens except:
a-easily aroused
b-drowsy most of the time
c-excitable
d-preoccupied with visual hallucinations
e-fast activity in the electroencephalogram

2-In Freudian psychopathology, the id:

a-develops from libido
b-characteristically seeks delayed gratification of its needs
c-characteristically entertain hallucinatory wish fulfilment
d-give rise to superego
e-typically works on death principle

3-Tactile hallucinations occur in:

a-hebephrenic schizophrenia
b-alcohol polyneuritis
c-heroin addiction
d-dermatitis artefacta
e-Korsakoff’s psychosis

4-Brief focal dynamic psychotherapy is characterised by:

a-the primary focus is on the Oedipus complex
b-the focus is pointed out at later stage of the therapy
c-the family members are often involved in the therapy
d-it usually does not last for more than 8 weeks
e-the emphasis is on current problems rather than relationships with important figures
in the patient’s past

5-The diagnostic features of parkinson’s disease include all the following except;
a-bradykinesia
b-cogwheel rigidity
c-lead-pipe rigidity
d-rest tremor
e-clasp-knife rigidity

6-The lesions of the parietal lobe may cause the following except:
a-agraphia
b-astereognosis
c-grasp reflex
d-anosognosia
e-homonymous hemianopia
7-Regarding neurofibrillary tangles :
a-they are not usually present in all layers of the cerebral cortex
b-the degree of tangle formation is inversely related to the severity of the clinical
condition
c-they are seen in abundance in the brains of people over 75 years of age
d-they are intracellular structures
e-they are characteristic features of multi-infarct dementia

8-Ataxia may be caused in therapeutic dose by:

a-imipramine
s-chlorpromazine
c-lithium carbonate
d-carbamazepine
e-olanzepine

9-A common side effect of amitriptyline is :

a-insomnia
b-diarrhoea
c-vomiting
d-fine tremor
e-diplopia

10-Which of the following statements made by a 15 year-old girl is suggestive of

schizophrenic disorder:
a-my head teacher is taking my thoughts away from my head
b-the police are going to arrest me
c-I hear the voice of my dead mother just before I go to sleep
d-my next-door neighbours say bad things about me
e-the television spreads rumours about me

11-Which of the following is not a characteristic feature of hypomania:

a-inflated self-image
b-periods of transient depressive mood
c-a feeling of extreme happiness
d-impaired concentration
e-parsimony

12-The DSM IV (Diagnostic and Statistical Manual) differs significantly from

ICD-10 (International classification of diseases) in one of the following manners:
a-overall it has fewer specific categories
b-it has more specific categories in affective disorders
c-it has fewer specific categories childhood psychiatric disorders
d-it gives no guidance regarding any possible source of error in making a diagnosis
e-unlike ICD-10 it is not a multiaxial classification

13-In a model psychiatric interview:

a-if the patient is allowed to talk freely, clinically relevant material will be offered
spontaneously
b-it is often wise to talk about major abnormalities first
c-Mental state examination always comes after taking full history
d-silent pauses are not as important as questions in the clinical interview
e-there is a little place for non-directive facilitating style

14-There is a direct evidence for one of these theories in the aetiology of

schizophrenia:
a--Kelly’s personal construct theory
b-the “schizophrenogenic mother” theory
c-the genetic predisposition theory
d-the dopamine theory
e-the transmethylation hypothesis

15-Schizophrenic thought disorders include all the following except:

a-concreteness
b-perseveration
c-over-inclusion
d-condensation
e-displacement

16-Which of the following is incorrect about placebo

a-it can cause severe side effects such as dermatitis
b-it can cause dependency
c-the shape and the size are important in placebo effect
d-the doctor-patient relationship is significant in placebo treatment
e-it is an essential component of every double-blind drug trial

17-Features of the id include all the followings except:

a-no concept of time
b-wish fulfilment
c-always unconscious
d-primary process thinking
e-conscience

18-The “basic assumptions” of Bion

a-are the therapeutic aim of groups
b-include “fight-flight” which means that anxiety levels are high
c-include pairing
d-should not be tackled to allow group work to proceed
e-only apply to psychotherapy group

19-Which of the following is not a defence mechanism:

a-regression
b-isolation
c-turning against the self
d-omitting
e-undoing

20- The following are true about cognitive therapy for depression except:
a-is associated with the name Beck
b-has been shown to be less effective than tricyclics in general practice dpression
c-it challenges “negative automatic thoughts”
d-it may be combined with a behavioural approach
e-it uses the concept of cognitive distortion, including “arbitrary inference”

21-In a patient with unipolar depressive illness, the primary diagnosis would
need to be reconsidered in the presence of :
a-hallucinations
b-obsessional thoughts
c-two attacks of retrobulbar neuritis
d-new evidence of life long anankastic personality disorder
e-new development of persecutory delusions

22-The following techniques are useful in taking a psychiatric history except:

a-framework statements
b-restitution
c-recapitulation
d-directive questioning
e-summarising

23-Cholinergic transmission is interrupted in all the following except:

a-post-poliomyelitis
b-Alzheimer dementia
c-patients taking neuroleptics
d-Parkinson’s disease
e-patients taking biperiden

24-The following are features of high suicidal intent except:

a-cutting the throat superficially
b-leaving a suicide note
c-settling affairs
d-taking dangerous drug
e-making the attempt in a hotel

25-Negative symptoms of schizophrenia include all the following except:

a-expressionless facies
b-blunting of affect
c-poverty of thought
d-thought block
e-self-neglect

26-Features of severe depression include all the following except:

a-mutism
b-Cotard’s syndrome
c-Couvade’s syndrome
d-agitation
e-visual hallucination

27-In delirium, one of the following is incorrect:

a-delusions are common
b-attention is reduced
c-the predominant affect is depression
d-registration is impaired
e-insight is limited

28-In dementia of Alzheimer type:

a-prevalence in the over-65s is about 20 %
b-there is a specific loss of memory function
c-“organic strategies” are used by the psychiatrist in interviewing
d-personality is well preserved compared with vascular dementia
e-apraxias are common when severity is moderate

29-The following are correct about tricyclic antidepressants except:

a-include lofepramine
b-prolong the P-R interval on the ECG
c-are all sedating
d-may cause weight gain
e-lower the fit threshold

30-Monoamine oxidase inhibitors may produce toxic effect in combination with

all the following except:
a-L-tryptophan
b-pethidine
c-pseudoephedrine
d-one pint of beer
e-banana skin
31-In neuroleptic malignant syndrome:
a-hypothermia is common
b-level of consciousness is preserved
c-mortality around 1 %
d-muscle tone is deceased
e-the blood pressure is labile

32-The following are features of borderline personality disorder except:

a-impulsivity
b-repeated deliberate self-harm
c-lack of remorse
d-feeling empty and bored
e-outburst of anger

33-Short-term (working memory)

a-improves in the evening
b-relies on episodic coding
d-relies on semantic coding
d-has the capacity of seven items
e-improves throughout adult life

34-Regarding long-term memory, the following are correct except:

a-has unlimited capacity
b-improves towards evening
c-improves by alcohol
d-relies on semantic coding
e-comprises semantic and episodic memory

35- The following are characteristic of the new variant of Creutzfeldt-Jacob

disease (CJD) except
a. early age of onset (19-39 years)
b. prominent psychiatric features
c- rapid progressive onset
d- exposure to the Bovine Spongiform Encephalopathy (BSE) agent is perhaps the
most plausible interpretation
e- Florid prion protein PrP Amyloid-plaques in brains of affected individuals

36- Regarding Senile dementia of Lewy body type, all the following are true
except
a- Lewy bodies are intracellular inclusions
b- patients present with acute or subacute confusional states
c- psychiatric symptoms are marked
d- extrapyramidal symptoms are remarkable
e- it accounts for 5% of dementia cases in patients over the age of 70 years *
37-The following are methods of coping with stress except:
a-denial
b-thematic apperception
c-conversion
d-palliation
e-intellectualisation

38-Behavioural treatments include all the following except:

a-aversion therapy
b-flooding
c-assimilation
d-token economy
e-systemic desensitisation

39-REM sleep is also known as :

a-orthodox sleep
b-paradoxical sleep
c-slow-wave sleep
d-deep sleep
e-stage four sleep

40-All the following are channels of non-verbal behaviour which indicate a state
of depression except:
a-dress
b-non-verbal vocalisation
c-touch
d-posture
e-pitch

41-Non-REM sleep is accompanied by:

a-a synchronised EEG
b-a desynchronised EEG
c-fast eye movement
d-increased heart rate
e-twitching of the extremities

42- The following are more common and more severe in non-dominant parietal
lesions except
a- ideomotor apraxia
b- unconcern over deficit, neglect of grooming, shaving, etc.
d- dressing apraxia
c- disturbance of prosodic components to language
d- anosognosia
43-Which of the following about extroverts is incorrect:
a-are difficult to condition
b-have a lower pain threshold than introvert
c-show faster extinction of conditioned responses
d-have a lower sedation threshold than introverts
e-are more likely to show hysterical conversion symptoms

44- The pathological changes in Wernicke’s encephalopathy occur in the

following areas except
a- Dorsomedial Thalamic Nuclei
b- Mamillary Bodies
c- Nucleus Basalis of Meynert
D- Anterior Hypothalamus
e- Walls of third Ventricles

45- The following are characteristic features of Korsakoff’s psychosis except

a- absence of clouding of consciousness
b- confabulation is an occasional feature
c- intact immediate memory
d- impaired recall of registered memory
e- impaired procedural memory (acquired motor skills)

46-The hyperkinetic syndrome:

a-usually appears before the age of 6 months
b-may lead to poor peer relationships
c-is usually associated with epilepsy
d-occur equally in boys and girls
e- attention deficit is very unlikely to persist into adulthood

47-Which one of the following disorders is more common in social class V:

a-senile dementia
b-AIDS
c-syphilis
d-manic depressive psychosis
e-early infantile autism

48-Which one of the following drugs is contraindicated in a patient with recent

history of angina:
a-carbamazepine
b-sodium valproate
c-tranylcypromine
d-lofepramine
e-mianserin

49-The therapeutic factor in group psychotherapy is:

a-altruism
b-scapegoating
c-pairing and sub-grouping
d-counter-transference
e-the imparting of information

50-The following are recognised unwanted side effects of benzodiazepines except:

a-ataxia
b-headache
c-nausea
d-amnesia
e-tinnitus

51-Which of the following statements is applicable to post-operative psychosis:

a-anterograde amnesia is present
b-clouding of consciousness is not usually present
c-it is invariably leads to schizophrenia
d-the patient should be nursed in a dark room
e-lability of affect is present

52-Wernicke’s encephalopathy is characterised by the following except:

a-paralysis of the lateral gaze
b-abrupt onset
c-double vision
d-clouded consciousness
e-cerebellar ataxia

53-The causes of nystagmus include all the following except :

a-barbiturate toxicity
b-treatment with phenytoin
c-Wernicke’s encephalopathy
d-lithium toxicity
e-Meniere’s syndrome

54-The following are recognised features of depression except:

a-overvalued ideas
b-ideas of reference
c-amnesia
d-exuberance
e-weight gain

55-Which one of the following statements about tics is incorrect:

a-they are commoner in boys
b-the peak age of onset is about 7 years
c- they are relieved by relaxation
d-they occur most commonly in the face and neck
e-multiple tics are common occurrence

56-Which one of the following is not a recognised side effect of chlorpromazine:

a-nightmares
b-nasal congestion
c-double vision
d-haemolytic anaemia
e-hypotension

57-The following are recognised features of anorexia nervosa except:

a-the age of onset is usually between 14 and 17 years of age
b-there is often a history being overweight
c-avoidance of carbohydrate
d-amenorrhoea may precede weight loss
e-loss of libido is unusual

58-For fitness to plead, which of following criteria is incorrect:

a-the prisoner should be able to instruct his counsel for defence
b-the prisoner should be able to follow the evidence in the court
c-the prisoner should not suffer from mental impairment
d-the prisoner should understand the significance of his plea
e-the prisoner should be able to challenge the jurors

59-Stuper may be a feature of the following except:

a-autism
b-psychotic depression
c-acute mania
d-hysteria
e-acute schizophrenia

60-Which of the following is incorrect about Carbamazepine:

a-it has agonist activity at ADH
b-it may be used in the treatment of affective disorders
c-it causes agranulocytosis in 1 in 5000 patients
d-it can be used with lithium carbonate
5-it induces its own hepatic metabolism

61-A diagnosis of schizophrenia over affective psychosis is favoured by:

a-paranoid delusions
b-cataplexy
c-an auditory hallucination saying, “you are mad”
d-delusion of reference
e-echoed thoughts

62-Absolute contra-indications to electroconvulsive therapy include:

a-epilepsy
b-pregnancy
c-a history of angina pectoris
d-age over 80
e-subarachnoid haemorrhage

63-Features of severe depression may include all the following except:

a-facial pain
b-nihilistic delusion
c-incongruent affect
d-hypersomnia
e-auditory hallucination

64-The following statements about puerperal psychosis are correct except:

a-occurs after 0.2 % of live births
b-has a 20 % recurrence rate after subsequent pregnancy
c-often present with insomnia
d-may be associated with perplexity and disorientation
e-carries a bad prognosis

65-In neuroleptic malignant syndrome:

a-marked extrapyramidal rigidity is atypical
b-profound hypothermia occurs
c-bromocriptine may provide effective treatment
d-further neuroleptic use is precluded after recovery
e-mortality rate is less than 5 %

66-Which of the following statements about chronic alcoholism is incorrect;

a-withdrawal fits may be prevented by intravenous chlormethiazole
b-Wernicke’s encephalopathy may be precipated by intravenous glucose
c-central pontine myelinolysis may occur
d-auditory hallucination may occur in clear conciousness
e-suicide risk is about 5 %

67-Which one of the following findings in anorexia nervosa is incorrect:

a-depressed T3 level
b-raised growth hormone level
c-raised cholesterol level
d-leucocytosis
e-flat, prolonged glucose tolerance curve
68-Severe mental subnormality is expected in:
a-XYY syndrome
b-Cri-du-chat syndrome
c-tuberous sclerosis
d-Hunter’s syndrome
e-Turner’s syndrome

69-Lithium carbonate may cause all the following except:

a-thirst
b-ataxia
c-hyperthyroidim
d-hypothyroidism
e-ECG changes

70-Dementia may be reversible in:

a-Pick’s disease
b-Creutzfeld-Jakob disease
c-Lewy body disease
d-normal pressure hydrocephalus
e-Huntington’s disease

71-The following may occur in agoraphobia except:

a-depersonalization
b-dyspnoea
c-chest pain
d-urine incontinence
e-fear of closed spaces

72-Features of normal grief reaction include all the following except:

a-hallucination of the dead person
b-the absence of mourning response in the first two weeks
c-intense preoccupation with the dead person after six months
d-self-reproach
e-suicidal thoughts

73-Features of chronic alcoholism include all the following except:

a-gynaecomstia
b-goose flesh
c-cerebral atrophy
d-the tendency for excess cigarette smoking
e-epilepsy

74-All the following about children who have spent many years in homes are
correct except:
a-stunted physical development
b-poor parenting skills
c-learning difficulties at school
d-enuresis
e-strong peer relationships

75-The non-accidental injury of a young child by a parent:

a-occurs only in advanced industrial countries
b-only happens to one child in the family
c-occurs when the parent has frequently been subjected to physical abuse as a child
d-is more common in boys than girls
e-is more often caused by the father than the mother

76-Bed-wetting may be treated with:

a-amphetamine
b-digoxin
c-imipramine
d-diuretics
e-a salt-free diet

77-Which of the following is a feature of Cotard’s syndrome:

a-nihilistic delusions
b-schizophrenoform features
c-the belief that she is pregnant
d-anosognosia and temporal disorientation
e-belief that the penis will disappear

78-Which one of the following is a feature of anorexia nervosa:

a-it being unknown over the age of 30 years
b-episodic bulimia
c-reduced pubic hair
d-avitaminosis
e-history of previous adolescent obesity is rare

79-Counter-transference:
a-is caused by unresolved oedipal conflicts in the patient
b-is characterised by hostility towards the therapist
c-when recognised helps the therapist to interpret the patient’s experiences
d-only occur in psychoanalytic setting
e-should be ignored as far as possible

80-In group therapy, the therapist aims to:

a-prevent the development of group culture
b-facilitate interpersonal learning
c-promote the development of small ideal democratic society
d-increase the patient’s tendency to idealise the therapist
e-only intervene if things get out of control
81-In a trial of a new psychotropic drug;
a-permission from an ethical committee in not advised
b-double-blind procedures are mandatory by law
c-the patient’s second degree relatives must be included in consenting
d-patients aged 18 and over can give consent
e-the lawyer must be informed

82-All the following about diazepam are correct except:

a-it has hypnotic effect
b-it has anticonvulsant effect
c-it has antidepressant effect
d-it releases aggressive impulses
e-it is a respiratory depressant

83- Long-acting depot neuroleptic:

a-are slowly absorbed because they are deeply injected
b-by-pass first-pass metabolism in the liver
c-must be given with antiparkinsonian drug
d-ineffective in the elderly
d-are ineffective when oral neuroleptics are not

84-Which of the following is a side effect of amitriptyline:

a-micturition
b-postural hypertension
c-blurring of vision
d-weight loss
e-diarrhoea

85-The following drugs are effective in the treatment of mania except:

a-promazine
b-haloperidol
c-sodium valproate
d-phenytoin
e-carbamazepine

86-The following are recognised features of obsessive compulsive neurosis

except:
a-depressed mood
b-folie de doute
c-preoccupation with the thought of violence
d-counting
e-hypochondriacal delusions

87-The following are characteristic of an obsessional personality except:

a-parsimony
b-rigidity
c-indecisiveness
d-projection
e-orderliness

88-Which one of the following statements about psychopathic personality is

incorrect:
a-responds well to psychiatric treatment
b-characterised by persistent aggression and antisocial behaviour
c-tends to diminish with age
d-leads to failure to establish loving relationships
e-may occur in those with high IQ

89-Erctile impotence may be caused by all the following except:

a: diabetes mellitus
b-excessive alcohol intake
c-fatigue
d-treatment with cimetidine
e-treatment with lithium carbonate

90-High suicide risk is more common in:

a-woman than men
b-winter than spring
c-wartime than peacetime
d-Catholics than Protestants
e-single than married people

91-Agood prognosis in schizophrenia is more likely if:

a-the illness develops gradually
b-the onset is before the age of 20
c-the patient lives in emotionally charged situation
d-manic depressive features are present
e-a distinct precipitant of onset is not evident

92-Schizophreniform psychoses occur in all the following except:

a-Parkinson’s disease
b-Huntington’s chorea
c-alcoholism
d-amphetamine addiction
e-heroin withdrawal syndrome

93-Autochthonous ideas
a-arise secondary to olfactory hallucination
b-are also called primary delusions
c-are related to passivity feelings
d-does not carry firm conviction
e-are most commonly seen in obsessional neurosis

94-The following are recognised aetiological factors in encopresis except:

a-constipation
b-mental handicap
c-the birth of a sibling
d-beginning toilet training at 18 months of age
e-unconscious hostility towards parents

95-Which of the following statements concerning family therapy is correct:

a-structural family therapy was first developed by Haley
b-mimesis is a technique of family therapy described by Haley
c-it has been shown to lower relapse rate in schizophrenia
d-enmeshment describes over rigid boundaries in the family system
e-general systems theory was described by Minuchin

96-The following characterise heroin withdrawal except:

a-rhinorrhoea
b-bradycardia
c-mydriasis
d-piloerection
d-diarrhoea

97-Which of the following statements concerning the hyperkinetic syndrome of

children is correct:
a-the diagnosis is more commonly used in the UK than the USA
b-hyperactivity specific to certain situations is a better diagnostic criterion than
generalised hyperactivity
c-fenfluramine has been widely used in treatment
d-growth retardation is a side effect of amphetamine treatment
e-in the Isle of Wight study,10 % of boys aged 10-11 were affected

98-Obsessional thoughts are:

a-expressed by the patient as not being his own
b-usually upsetting
c-believed in implicitly
d-ego-syntonic
e-indicative of psychosis

99-The following are at particular risk of alcoholism except:

a-social workers
b-sailors
c-barmen
d-cooks
e-journalists
100-The following predict suicide in depressed patients except:
a-being older
b-living alone
c-male six
d-family history of psychiatric illness
e-recent discharge from hospital

ANSWERS

1-b 2-c 3-a

4-e 5-e 6-c
7-d 8-d 9-d
10-a 11-e 12-b
13-a 14-c 15-b
16-e 17-e 18-c
19-d 20-b 21-c
22-b 23-d 24-d
25-d 26-c 27-c
28-e 29-c 30-d
31-e 32-c 33-d
34-c 35-c 36-e
37-b 38-c 39-b
40-c 41-a 42-a
43-b 44-d 45-e
46-b 47-c 48-c
49-a 50-e 51-e
52-c 53-d 54-d
55-e 56-c 57-e
58-c 59-a 60-c
61-e 62-e 63-c
64-e 65-c 66-e
67-d 68-b 69-c
70-d 71-d 72-c
73-b 74-e 75-c
76-c 77-a 78-b
79-c 80-b 81-d
82-c 83-b 84-c
85-d 86-e 87-d
88-a 89-e 90-e
91-d 92-e 93-b
94-d 95-c 96-b
97-d 98-c 99-a
100-d