June 2021 MCQ Psychiatry at DAMS

DAMS PSYCHIATRY
REVISION MCQ :
JUNE
DAMS PSYCHIATRY : MCQ OF THE DAY
01/06/2021
Basic Q for topic revision page “Dr. Sachin Arora,
DAMS Psychiatry”
Q 210.) A 20 year old boy c/o hearing of voices, aggressive behavior since 2 days. He
has fever since 2 days. When asked, his family said he has been muttering to self
and gesticulating. There is no h/o of psychiatric illness. Likely diagnosis here is:
A. Dementia B. Acute psychosis
C. Delirium D. Delusional disorder
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01/06/2021
Answer and explanation page “Dr. Sachin Arora,
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Ans 210.) B. Acute psychosis

Aggressive behaviour, muttering to self and gesticulating, less than 1
month duration, as per ICD-10 is acute psychosis.
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Q 211.) A 16 year old boy does not attend school because of the fear of being harmed
by school mates. He thinks that his classmates laugh at and talk about him. He is
even scared of going out to the market. He is most likely suffering from:
A. Anxiety neurosis B. Manic Depressive Psychosis
C. Adjustment reaction D. Schizophrenia.
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Ans 211.) D. Schizophrenia

Does not attend school suggests significant socio-occupational dysfunction. Fear of
being harmed by classmates, classmates laugh at him and talk about him suggests
delusion of persecution and reference. Diagnosis goes in favour of schizophrenia.
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Q 212.) A 22 y/o male with the diagnosis of schizophrenia was started on Risperidone 8
mg/d. Despite 6 weeks of continuous therapy patient did not show any improvement and his
medications were changed to Haloperidol which was gradually increased to 20 mg/d. The
patient did not show any response and continues to be symptomatic. What is the next best
course of action:
A. A combination of two typical antipsychotics
B.A combination of typical and atypical antipsychotics
C. Electroconvulsive therapy
D. Clozapine therapy
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Ans 212.) D. Clozapine therapy

This is a case of schizophrenia, where 2 different antipsychotics of 2 different
groups have been already tried but inadequate response. So, we need to give
clozapine here, as per guidelines.
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Q 213.) A 30 – years old pregnant woman comes to your clinic with decreased
sleep, increased appetite and hyperactivity for 2 weeks. A diagnosis of mania is
made. Further probing reveals four episodes of major depression in the past two
years. What drug will you prescribe to the patients?
a. Haloperidol b. Lithium
c. Promethazine d. Clonazepam
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Ans 213.) A. Haloperidol

Treatment guidelines in psychiatry suggest to avoid mood stabilizers in
pregnancy and to manage mania in pregnancy by antipsychotics (which are
relatively lesser teratogenic.)
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Q 214.) A patient with complaints of having a deformed nose. He has visited several plastic
surgeons but they have assured that there is nothing wrong with his nose. In spite of these
reassurances, he continues to believe that his nose is deformed, He also complains that nobody
takes him seriously because of the deformity of his nose, and he is extremely embarrassed
because of this. he is most probably suffering from:
A.Somatisation disorder
B. Hypochondriacal disorder
C. Delusional disorder
D.OCD
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Ans 214.) C. Delusional disorder

False, firm, fixed, unshakeable belief that patient holds(nose
deformed) irrespective of reassurances, goes towards DELUSION.
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Q 215.) A 34 year old housewife reports a three month history of feeling low, lack
of interest in activities, lethargy, multiple body-aches, ideas of worthlessness,
decreased appetite and disturbed sleep with early morning awakening. She is
likely to benefit form -
a) Anti-psychotics b) Anti-depressants
c) Anxiolytics d) Hypno-sedatives
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Ans 215.) B) ANTIDEPRESSANTS

The clinical picture described in this scenario matches with that of a
depressive episode(duration criteria) also satisfied.
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Q 216.) A middle aged man presented with pain in back, lack of interest in recreational activities,
low mood, lethargy, decreased sleep and appetite for two months. There was no history
suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness.
There was no family history of psychiatric illness. Routine investigations including hemogram,
renal function tests, liver function tests electrocardiogram did not reveal any abnormality. This
patient should be treated with
a) Haloperidol b) Sertraline
c) Alprazolam d) Olanzapine
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Ans 216.) B : SERTRALINE

In this clinical scenario, also the clinical picture is suggestive of a depressive
episode, and we will treat him with antidepressant (sertraline)
(PEARL : SSRI ARE DRUG OF CHOICE IN ALL DEPRESSION, SERTRALINE
BEING SAFER IN DIABETIC PATIENTS)
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Q 217.) A 20 year old man has presented with increased alcohol consumption and sexual
indulgence, irritability, lack of sleep, and not feeling fatigued even on prolonged periods
of activity. All these changes have been present for 3 weeks. The most likely diagnosis is
-
a. Alcohol dependence b. Schizophrenia
c. Mania d. Impulsive control disorder
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Ans 217.) C. Mania

The patient given in clinical scenario matches with symptoms of
mania.
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Q 218.) A 67 year old lady is brought in by her 6 children saying that she has gone senile. Six
months after her husband's death she has become more religious, spiritual and gives lot of
money in donation. She is occupied in too many activities and sleeps less. She now believes that
she has a goal to change the society. She does not like being brought to the hospital and is
argumentative on being questioned on her doings. The diagnosis is -
a) Acute manic excitement b) Delusion
c) Schizophrenia d) Depression
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Ans 218.) A. Acute manic excitement

The clinical picture (goal directed activity, religiousity, donation etc) points
towards diagnosis of mania.
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Q 219.) A 42 year old male with a past history of a manic Episode presents with
an illness of 1 month duration characterized by depressed mood, anhedonia and
profound psychomotor retardation. The most appropriate management strategy
is prescribing a combination of-
a) Antipsychotics and antidepressants
b) Antidepressants and mood stabilizers
c) Antipsychotics and mood stabilizers
d) Antidepressants and benzodiazepines
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Ans 219.) B. Antidepressants and mood stabilizers

The patient has presented currently in depression like state. But there is previous history of maniac
episode, so the diagnosis for this scenario is “Bipolar Disorder, currently in depression”.
We need to treat depression with antidepressants under the cover of mood stabilizer because, not
only we need to treat depression but also we need to prevent further episodes. So, mood stabilizer is
needed in order to prevent maniac as well as depressive episodes in bipolar disorder.
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Q 220.) MS. B, a 27 year old nurse had decreased interest in talking and painting. She had a
breakup relationship with her boy friend. Two months later she lost interest in her hobbies and
was convinced that she would not be able to work again. She thought life was not worth living
and has consumed 60 tablets of phenobarbitone to end her life, she is most likely suffering from -
a. Adjustment disorder
b. Acute stress disorder
c. Depressive disorder
d. Post-traumatic stress disorder (PTSD)
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Ans 220.) C. Depressive disorder

Presence of suicidal attempt in this question points more towards diagnosis of a depressive
episode. Even adjustment disorder has depressive symptoms, we call it adjustment with
prolonged depressive reaction. But in diagnostic criteria, it is mentioned that in order to
diagnose adjustment disorder, symptoms should not be so predominant that other more
specific depressive or anxiety disorders can be diagnosed.
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Q 221.) A 59 yr old teacher with three decades in public service is depressed that he is going
to be retired soon, he was prescribed with antidepressant. On 7th day of the treatment, he
comes with the acute retention of urine, the offending drug could be-
a. Chlorpromazine b. Clozapine
c. Olanzapine d. Amitryptyline
e. Sertraline
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Ans 221.) D. Amitryptiline

The antidepressant most likely to cause retention of urine is
amitryptiline (causing anticholinergic side effects).
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Q 222.) A female patient on treatment for depression took a massive dose of
amitryptiline for suicide. Which of the following statement regarding her
management is wrong?
a. Gastic lavage to be done
b. Sodium bicarbonate should be administered to treat acidosis
c. Atropine sulphate should be administered as an antidote
d. Diazepam should be injected to control seizures
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Ans222.) C. Atropine sulphate should be

administered as an antidote
Tricyclic antidepressant poisoning causes anticholinergic crisis, where
cholinergic drugs like physostigmine are used. Although for acidosis, we give
sodium bicarbonate, gastric lavage can be done, diazepam to control seizures.
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Q 223.) An 85-year-old man is brought to the psychiatrist by his wife. She states that for the last 4
months, since the death of his son, the patient has been unable to sleep, has lost 2.5 kgs, has
crying spells, and in the last week has been starting to talk about suicide. She notes that he has
numerous other medical problems, including prostatic hypertrophy, hypertension, insulin-
dependent diabetes, and a history of myocardial infarction. Whichof the following medications is
most appropriate for the treatment of this patient?
a. Doxepin b. Clonazepam
c. Sertralin d. Amitriptyline
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Ans 223.) C. Sertraline

The clinical scenario matches with that of depressive episode. And
SSRI drugs are the first line treatment in depression, moreover
sertraline is preferred in diabetics and elderly.
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Q 224.) Ram has depressed mood for several months. His wife informs you that he tried to kill
himself last month when he reported hearing voices that told him to kill himself. He was
hospitalized for 21 days and given a diagnosis of a major depressive disorder. When questioned,
he reported having "given up'. He also has a 10-year history of alcoholism. Which of the following
would pose the greatest risk for future completed suicide?
a) Feelings of helplessness b) Marital status

c) Affective disorders d) Past suicide attempt
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Ans 224.) D. Past suicidal attempt
The clinical scenario in this question is severe depression with psychotic symptoms. (Suicidal attempt +
hallucinations)
Risk factors for suicide:
• Previous suicide attempt (most imp)
• Family history of suicide
• Male gender
• Family history of child abuse
• History of mental disorders, particularly clinical depression
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Q 225.) A 41 year old woman presented with a history of aches and pains all over the body and
generalized weakness for four years. She cannot sleep because of the illness and has lost her
appetite as well. She has lack of interest in work and doesn't like to meet friends and relatives. She
denies feelings of sadness. Her most likely diagnosis is –
a) Somatoform pain disorder
b) Major depression
c) Somatization disorder
d) Dissociative disorder
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Ans 225.) B. Major depression

Although in this case, patient denies feeling of sadness, but decreased interest
in work and activities, along with biological rhythm related disturbances like
decreased sleep and decreased appetite and somatic symptoms points towards
diagnosis of major depression
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Q 226.) A patient comes in stupor condition, patient's parents give history of
being continually sad and suicidal attempts, not eating and sleeping most of the
time. The treatment is -
a) ECT b) Antidepressant
c) Antipsychotic d) Sedatives
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Ans 226.) A. ECT

For depression with stupor and suicidal attempts, ideal treatment of
choice is ECT.
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Q 227.) A 50 year old male presents with a 3 year history of irritability, low mood,
lack of interest in surroundings and general dis-satisfaction with everything. He
has no significant disruption of sleep or appetite. This is likely to be:
A. Major depression B. No psychiatric disorder
C. Dysthymia D. Chronic fatigue syndrome
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Ans 227.) C. Dysthymia

3 year history of low mood, lack of surroundings, is suggestive of dysthymia
(minimum duration needed to diagnose 2 years)
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Q 228.) A patient suffering from bipolar disorder, getting episodes of mania
and depression, because of poor compliance to drugs, psychotherapy of
choice?
a.Cognitive behavioural Therapy
b.Psycho-education
c.Insight oriented therapy
d.Supportive psychotherapy
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Ans 228.) B. Psychoeducation
• Maintain dual treatment focus: (1) acute short term and (2) prophylaxis.
• Mania as medical emergency: Treat first, chemistries later.
• Load valproate and lithium; titrate lamotrigine slowly.
• Careful combination treatment can decrease adverse effects.
• Augment rather than substitute in treatment-resistant patient.
• Retain lithium in regimen for its antisuicide and neuroprotective effects.
• Taper lithium slowly, if at all.
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Q 229.) A 32-year-old woman is brought to the emergency room by the police after she was found
standing in the middle of a busy highway, naked, commanding the traffic to stop. In the
emergency room she is agitated and restless, with pressured speech and an affect that alternates
between euphoric and irritable. Her father is contacted and states that this kind of behavior runs
in the family. Which of the following is the most likely diagnosis?
a. Delirium
b. Bipolar disorder, manic
c. Bipolar disorder, mixed state
d. Schizophrenia
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Ans 229.) B. Bipolar disorder, manic

“agitated, restless, pressured speech and an affect that alternates between
euphoric and irritable” along with behaviour to stop traffic with positive family
history points towards diagnosis of bipolar disorder.
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Q 230.) A 32-year-old man is started on Lithium after being diagnosed with bipolar
disorder. His psychiatrist explains the risks and benefits of the drug and tells the
patient that the drug can affect several organs in the body and he will need blood
tests every 6 months. Which of the following labs should be drawn that often on
this patient?
a.) T3RU. b.) TSH.
c.) BUN. d.) CBC.
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Ans 230.) B.) TSH levels

Lithium causes hypothyroidism, so, we need to check for TSH levels
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Q 231.) A patient with rapid cycling bipolar disorder was well maintained on carbamazepine,
developed skin rash. Psychiatrist tapered the doses, and gradually cross-titrated to
oxcarbazepine (newer congener of carbamazepine) but even on oxcarbazepine, the following
problem is what the psychiatrist has to be careful about:
a. Vertigo b. Steven Johnson syndrome
c. Hyponatremia d. Hepatitis
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Ans 231.) C. Hyponatremia

Oxcarbazepine causes less skin side effects than carbamazepine, but
more of hyponatremia
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Q 232.) A 29-year-old woman with a previous diagnosis of bipolar disorder is hospitalized
during an acute manic episode. She is elated, sexually provocative, and speaks very fast,
jumping from one subject to another. BUN, creatinine, electrolytes, TSH, and an ECG are
within normal limits. What other test is necessary before starting the patient on lithium?
a. Pregnancy test b. Total bilirubin
c. EEG d. Chest x-ray
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Ans 232.) A. Pregnancy test

Lithium causes teratogenecity (ebstein’s anomaly),so pre-
lithium investigation we need to do pregnancy test
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Q 233.) A 45-year-old woman has thin legs and arms but a considerable amount of fat
deposited on her abdomen, chest, and shoulders. Her skin is thin and atrophic and she has
several purple striae on her abdomen. An MRI shows the presence of a pituitary adenoma.
The psychiatric disorder most commonly associated with this syndrome is
a. Depression b. Psychosis
c. Organic mental disorder d. Mania
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Ans 233.) A. Depression
Cushing’s syndrome, due to exogenous administration of corticosteroids and more rarely to
adrenocarcinoma or ectopic production of ACTH, is often associated with psychiatric disturbances.
Depression and mixed anxiety and depressive states are the most common psychiatric
manifestations of the syndrome (from 35 to 68%, depending on the study).
Mania, psychosis, delirium, and cognitive disturbances also occurs but at a much lower rate.
Depressive symptoms occur early in the disorder—in 27% of cases in the prodromal period. Most
patients improve after the primary disorder is treated and serum cortisol decreases.
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Q 234.) A 40-year-old woman reports that over the past 6 months she has had little appetite,
sleeps poorly, and has lost interest in her normal activities. Physical exam is unremarkable.
Which of the following is the most likely laboratory finding in this woman?
a. Positive dexamethasone suppression test (DST)
b. Normal growth hormone regulation
c. Increased 5-hydroxyindoleacetic acid (5-HIAA) levels
d. Normal melatonin levels
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Ans 234.) a. Positive dexamethasone suppression
test (DST)
Poor appetite, poor sleep, and lack of interest in usual activities characterize patients who
have major depression. In this depressed woman, the dexamethasone suppression test is
likely to be positive. A positive result is seen when the synthetic glucocorticoid
dexamethasone fails to suppress the secretion of cortisol as it would in a patient with a
normal mood. Also, in depression there may be abnormal growth hormone regulation and
melatonin levels, and decreased 5-HIAA.
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Q 235.) A 45-year-old female patient reports that over the last 3 months she has lost her
appetite and interest in her usual activities, and often feels that life is not worth living.
Compared with typical sleep, in this patient the percentage of REM sleep, percentage of
delta sleep, and sleep latency, respectively, are most likely to
a. increase, decrease, decrease
b. increase, decrease, increase
c. decrease, stay the same, increase
d. decrease, decrease, increase
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Ans 235.) b. increase, decrease, increase
This woman’s symptoms indicate that she is likely to be experiencing a major

depressive episode. Sleep in major depression is associated with increased REM
sleep, reduced delta sleep, and increased sleep latency.
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Q 236.) A patient presented in casualty with a history of sudden palpitation,
sensation of impending doom and constriction in his chest. This lasted for about
10-15 minutes after which he became all right. The diagnosis is likely to be -
a. Phobia
b. Personality disorder
c. Generalized anxiety disorder
d. Panic attack
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Ans 236.) D. Panic attack

The clinical scenario, with sudden acute paroxysmal anxiety with feeling of
impending doom (catastrophe) is s/o panic attack.
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Q 237.) A middle aged person reported to Psychiatric OPD with the complaints of
fear of leaving home, fear of travelling alone and fear of being in a crowd. He
develops marked anxiety with palpitations and sweating if he is in these situations.
He often avoids public transport to go his place of work. His most likely diagnosis is-
a) Generalised anxiety disorder b) Schizophrenia
c) Personality disorder d) Agoraphobia
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Ans 237.) d) Agoraphobia

In the question, “fear of leaving home, fear of travelling alone and fear of being
in a crowd” is suggestive of agoraphobia. Moreover patient has anxiety
symptoms in these situations.
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Q 238.) A 15 year old boy feels that the dirt has hung onto him whenever he passes through the dirty
street. This repetitive thought causes much distress and anxiety. He knows that there is actually no
such thing after he has cleaned once but he is not satisfied and is compelled to think so. This has led
to social withdrawal. He spends much of his time thinking about the dirt and contamination. This has
affected his studies also. The most likely diagnosis is -
a. Obsessive compulsive disorder
b. Conduct disorder
c. Agoraphobia
d. Adjustment disorder
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Ans 238.) a. Obsessive compulsive disorder

The patient has repetitive thoughts of dirt contamination, which he knows are
irrational thoughts, and it is causing him distress. This is suggestive of obsessive
compulsive disorder.
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Q 239.) A 25 year old female presents with 2 year history of repetitive, irresistible thoughts
of contamination with dirt associated with repetitive hand washing. She reports these
thoughts to be her own and distressing; but is not able to overcome them along with
medication. She is most likely to benefit from which of the following therapies-
a) Exposure and response prevention
b) Systematic desensitization
c) Assertiveness training
d) Sensate focusing
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Ans 239.) a) Exposure and response prevention

The clinical scenario is of OCD, where psychotherapy is treatment of choice.
Psychotherapy of choice in OCD is “exposure and response prevention”.
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June 2021 MCQ Psychiatry at DAMS

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DAMS PSYCHIATRY

Ans 210.) B. Acute psychosis

Ans 211.) D. Schizophrenia

Ans 212.) D. Clozapine therapy

Ans 213.) A. Haloperidol

Ans 214.) C. Delusional disorder

Ans 215.) B) ANTIDEPRESSANTS

Ans 216.) B : SERTRALINE

Ans 217.) C. Mania

Ans 218.) A. Acute manic excitement

Ans 219.) B. Antidepressants and mood stabilizers

Ans 220.) C. Depressive disorder

Ans 221.) D. Amitryptiline

Ans222.) C. Atropine sulphate should be

Ans 223.) C. Sertraline

a) Feelings of helplessness b) Marital status

Ans 225.) B. Major depression

Ans 226.) A. ECT

Ans 227.) C. Dysthymia

Ans 229.) B. Bipolar disorder, manic

Ans 230.) B.) TSH levels

Ans 231.) C. Hyponatremia

Ans 232.) A. Pregnancy test

Ans 235.) b. increase, decrease, increase

This woman’s symptoms indicate that she is likely to be experiencing a major

Ans 236.) D. Panic attack

Ans 237.) d) Agoraphobia

Ans 238.) a. Obsessive compulsive disorder

Ans 239.) a) Exposure and response prevention

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