Psychiatry MCQs for NEET PG
933 worked Psychiatry questions across 109 areas. Each one has its own page with the reasoning for every option.
What this set is
Psychiatry covers disorders and their treatment. Definitions, classification, drug side effects and first-line management are the reliable parts.
This page lists the 933 Psychiatry questions that have a full worked page: 698 application questions that put a fact to use on a patient or a finding, and 235 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Psychiatry practice bank in the app is larger, with 3,403 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Psychiatry test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Psychiatry covers in the exam
- Psychotic disorders
- Mood disorders
- Anxiety and related disorders
- Substance use
- Organic mental disorders
- Eating and sleep disorders
- Psychopharmacology
- Child and adolescent psychiatry
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Psychiatry study guide.
Worked questions by area
109 areas, largest first. Open an area to see its questions.
Substance use83
- Substance use · ApplicationWhich drug class is used to manage alcohol withdrawal?
- Substance use · ApplicationA man who uses heroin is admitted and has had no drug for twelve hours. He is fully oriented but has yawning, watering eyes, a running nose, dilated pupils, piloerectio…
- Substance use · Multi-stepA man with opioid dependence is stabilised on buprenorphine-naloxone sublingual tablets. Which statement about buprenorphine explains why it is safer than methadone in…
- Substance use: alcohol withdrawal timeline · ApplicationA man with chronic alcohol dependence stops drinking. Which sequence of events is typical?
- Substance use: delirium tremens · ApplicationOn day 3 after admission for a femur fracture, a chronic drinker is disorientated, sees insects crawling on the wall, and has tachycardia, fever and coarse tremor. The…
- Substance use: Wernicke encephalopathy · ApplicationA malnourished alcoholic presents with confusion, nystagmus, bilateral lateral rectus palsy and a wide-based gait. What should be given first?
- Substance use: Korsakoff syndrome · ApplicationAfter recovering from an episode of Wernicke encephalopathy, a patient cannot form new memories, and fills the gaps in his recall with fluent fabricated stories. This is:
- Substance use: acamprosate · ApplicationWhich drug helps maintain abstinence in alcohol dependence by modulating glutamate (NMDA) and GABA neurotransmission, and is contraindicated in severe renal impairment?
- Substance use: naltrexone · ApplicationNaltrexone is useful in both alcohol dependence and opioid dependence because it:
- Substance use: opioid withdrawal · ApplicationA man stopped heroin 24 hours ago. He has yawning, lacrimation, rhinorrhoea, piloerection, dilated pupils, abdominal cramps and muscle aches. Which drug helps to contro…
- Substance use: opioid substitution · ApplicationWhich drug is a partial mu agonist used for opioid substitution, with a ceiling effect on respiratory depression?
- Substance use: cocaine · ApplicationA man who has used cocaine heavily reports the feeling of insects crawling under his skin and picks at his skin. This is:
- Substance use: amphetamine psychosis · ApplicationA college student using methamphetamine develops paranoid delusions and hallucinations while fully alert. Which feature favours substance-induced psychosis?
- Substance use: hallucinogens · ApplicationA young man at a party experiences vivid visual hallucinations, synaesthesia (hearing colours) and a distorted body image with preserved orientation. The probable drug…
- Substance use: nicotine dependence · ApplicationVarenicline helps smoking cessation because it is:
- Substance use: alcohol biomarkers · Multi-stepWhich laboratory marker is most specific for recent heavy alcohol consumption (more than 60 g per day for over a week)?
- Substance use: ICD-10 dependence · ApplicationAccording to ICD-10, a diagnosis of dependence syndrome requires at least how many of the six features at some time during the previous year?
- Substance use: alcoholic hallucinosis · ApplicationA chronic drinker reduces his intake and then hears accusatory voices talking about him in the third person, while remaining orientated and with a clear sensorium. The…
- Substance use: benzodiazepine withdrawal · ApplicationA woman who has been taking alprazolam 4 mg daily for years stops abruptly and has a generalised seizure, with anxiety and tremor. Prevention depends on:
- Substance use: MDMA · Multi-stepA teenager at a rave develops hyperthermia, agitation, muscle rigidity and hyponatraemia after taking ecstasy. The drug primarily causes the release of:
- Substance use: phencyclidine · Multi-stepAn aggressive agitated man has vertical and horizontal nystagmus, a blank stare, analgesia and hypertension after using a dissociative drug. This is typical of intoxica…
- Substance use: Edwards and Gross dependence · ApplicationWhich feature of the alcohol dependence syndrome describes drinking to avoid withdrawal symptoms, and drinking early in the morning?
- Substance use: disulfiram reaction · ApplicationA patient on disulfiram drinks alcohol and develops flushing, throbbing headache, nausea, hypotension and palpitations. Which metabolite accumulates?
- Substance use: baclofen in liver disease · Multi-stepA man with alcohol-related cirrhosis wants a drug to reduce craving. Naltrexone and disulfiram are unsuitable because of hepatic risk. Which is the better option?
- Substance use: fetal alcohol syndrome · ApplicationA newborn has a smooth philtrum, thin upper lip, short palpebral fissures and microcephaly. The mother drank heavily in pregnancy. This is
- Substance use: inhalants · ApplicationA 14-year-old boy found with a rag soaked in solvent has perioral rash, slurred speech and euphoria. What serious risk is associated with inhalant misuse?
- Substance use: buprenorphine induction · Multi-stepA heroin user who took heroin four hours ago is given sublingual buprenorphine and promptly develops severe withdrawal symptoms. This occurs because buprenorphine
- Substance use: methadone and QT · Multi-stepA patient maintained on methadone starts clarithromycin and later has syncope. Which ECG finding is most likely?
- Substance use: cocaine intoxication management · Multi-stepA young man with cocaine intoxication has chest pain, agitation, a heart rate of 130 and a blood pressure of 180/110. Which drug is the first-line choice?
- Substance use: synthetic cannabinoid intoxication · Multi-stepA 20-year-old is brought after smoking a herbal incense mixture. He is agitated, tachycardic, hypertensive and has had a seizure, and he is paranoid. His routine urine…
- Substance use: urine detection window of cannabis · Multi-stepA 28-year-old daily heavy cannabis user and a person who snorted cocaine at a party both stopped use 10 days ago, and both give urine samples. Which result is most like…
- Substance use: harm reduction for injecting drug use · ApplicationIn a district with heavy injecting of heroin and an HIV outbreak among users, a programme aims to cut transmission. Which combination is the evidence-based harm reducti…
- Substance use: cannabis withdrawal · ApplicationA 25-year-old man who smoked cannabis daily for three years stops abruptly. Over the next week he is irritable, sleeps poorly, has vivid dreams, reduced appetite and re…
- Substance use: alcoholic ketoacidosis · Multi-stepA 40-year-old man who drinks heavily and has eaten little for three days presents with vomiting, abdominal pain and rapid breathing. The anion gap is raised, the blood…
- Substance use: cocaine in pregnancy · Multi-stepA 27-year-old woman at 32 weeks of gestation who snorted cocaine two hours earlier develops severe constant abdominal pain, a hard tender uterus and dark vaginal bleedi…
- Substance use: abstinence violation effect · ApplicationA man abstinent from alcohol for five months has one drink at a wedding. He thinks, 'I have ruined it, I am a failure,' and drinks heavily for the next three weeks. Whi…
- Substance use: caffeine withdrawal · ApplicationA regular heavy coffee drinker who stops abruptly while fasting for a procedure develops a throbbing headache, fatigue and difficulty concentrating the next morning. Wh…
- Substance use: Marchiafava-Bignami disease · Multi-stepA 52-year-old man who has drunk country liquor heavily for decades develops progressive dementia, dysarthria, gait disturbance and a seizure. Which MRI finding would be…
- Substance use: cocaine with alcohol · Multi-stepA 30-year-old man who drank heavily while using cocaine develops chest pain and an arrhythmia. A toxicologist says a metabolite formed only when the two are combined in…
- Substance use: ketamine misuse · ApplicationA 24-year-old who frequently uses ketamine at parties for months has urinary frequency, urgency and suprapubic pain with blood in the urine. Cultures are sterile. What…
- Substance use: Cloninger typology of alcoholism · Multi-stepA 27-year-old man whose father was alcohol-dependent began drinking in his teens. He has a history of fights and theft, seeks thrills, feels little guilt, and drinks he…
- Substance use: Jellinek species of alcoholism · Multi-stepA man in a wine-growing region drinks steadily every day. He has never lost control once he starts, and he can limit a session. He suffers withdrawal if he abstains and…
- Substance use: amotivational syndrome · ApplicationA 24-year-old who has smoked cannabis daily for years shows apathy, loss of ambition, poor performance in college and neglect of grooming. He is sober at the interview…
- Substance use: naloxone duration of action · ApplicationA man with heroin overdose recovers fully after intravenous naloxone and refuses admission. Ninety minutes later he is found drowsy with a respiratory rate of 6 per min…
- Substance use: nicotine withdrawal · ApplicationA smoker stops cigarettes abruptly. Within a day he becomes irritable, restless and unable to concentrate, and over the next weeks he feels constantly hungry, gains wei…
- Substance use: anabolic steroid misuse · ApplicationA 26-year-old bodybuilder has become irritable and aggressive. Examination shows severe acne, small testes, gynaecomastia and a low sperm count. Which substance is he m…
- Substance use: buprenorphine-naloxone combination · Multi-stepOpioid substitution clinics often prescribe buprenorphine combined with naloxone as a sublingual tablet rather than buprenorphine alone. What is the reason for adding n…
- Substance use: benzodiazepine choice in liver disease · ApplicationA 55-year-old man with decompensated cirrhosis (ascites, prolonged prothrombin time) is admitted with sweating, tremor and anxiety 20 hours after his last drink. Which…
- Substance use: osmotic demyelination after sodium correction · Multi-stepA malnourished chronic drinker is admitted with a serum sodium of 106 mmol/L, and the level is corrected to 128 mmol/L within 24 hours. Four days later he develops dysa…
- Substance use: alcoholic cerebellar degeneration · ApplicationA 52-year-old man with 25 years of heavy drinking has a slowly progressive wide-based, unsteady gait. Heel-to-shin testing is markedly abnormal, while arm coordination…
- Substance use: alcoholic blackout · ApplicationA 28-year-old man drank heavily at a wedding, danced, talked sensibly with relatives and drove home. The next morning he cannot recall anything from after 9 pm. Witness…
- Substance use: starting naltrexone in opioid dependence · Multi-stepA man dependent on heroin has completed detoxification and wishes to start oral naltrexone for relapse prevention. His last heroin use was two days ago. What is the saf…
- Substance use: neonatal abstinence syndrome · ApplicationA 2-day-old term baby of a mother who used heroin throughout pregnancy has a high-pitched cry, tremors, sneezing, yawning, poor feeding, loose stools and excessive suck…
- Substance use: opioid dependence in pregnancy · ApplicationA woman with heroin dependence presents at 14 weeks of pregnancy wanting to stop. Which management is generally recommended?
- Substance use: cannabinoid hyperemesis syndrome · Multi-stepA 26-year-old man who has smoked cannabis daily for years has recurrent episodes of intense nausea, repeated vomiting and abdominal pain. He finds that long hot showers…
- Substance use: kindling in alcohol withdrawal · ApplicationA 48-year-old man has completed several alcohol detoxifications over the years. His latest withdrawal is complicated by seizures, although he was drinking less than bef…
- Substance use: hallucinogen persisting perception disorder · ApplicationA 24-year-old man who stopped using LSD four months ago repeatedly sees trailing images behind moving objects and geometric patterns in his visual field. He recognises…
- Substance use: biochemical lesion in Wernicke encephalopathy · Multi-stepA chronic drinker with nystagmus, ataxia and confusion is found to have a reduced red-cell enzyme activity that improves after parenteral vitamin therapy. Which enzyme…
- Substance use: neuroanatomy of Korsakoff syndrome · ApplicationA man with long-standing alcohol dependence has severe anterograde amnesia and confabulation. At autopsy, which structures are characteristically damaged?
- Substance use: Datura poisoning · ApplicationA man is brought to the emergency room after eating a preparation containing Datura seeds. He is agitated and delirious with dilated pupils, hot dry flushed skin, tachy…
- Substance use: seizures in alcohol withdrawal · Multi-stepA 44-year-old man has a generalised tonic-clonic seizure 24 hours after stopping heavy drinking. He has no history of epilepsy and CT head is normal. Which statement ab…
- Substance use: liver enzyme pattern in alcohol · ApplicationA 46-year-old man with suspected alcohol dependence has aspartate aminotransferase 180 U/L, alanine aminotransferase 70 U/L and raised gamma-glutamyl transferase. Which…
- Substance use: buprenorphine formulation · ApplicationA patient with opioid dependence is started on buprenorphine tablets that must be dissolved under the tongue and not swallowed. What is the reason for this route?
- Substance use: tolerance to opioid effects · Multi-stepA man has been taking high-dose oral opioids for years and now tolerates doses that would have been fatal to a naive user. Which effect will show the least tolerance de…
- Substance use: methadone versus heroin withdrawal · ApplicationTwo patients stop their opioids abruptly, one after long-term heroin use and the other after long-term methadone. How will the methadone withdrawal compare with the her…
- Substance use: risk of delirium tremens · Multi-stepA 50-year-old alcohol-dependent man is admitted for a hernia repair. Which feature most strongly predicts that he will develop delirium tremens?
- Substance use · ApplicationTremor and seizures after alcohol cessation suggest what?
- Substance use · ApplicationMiosis and slow breathing suggest what?
- Substance use · ApplicationWhat syndrome can occur after abrupt cessation of prolonged alcohol use?
- Substance use · ApplicationWhich sign is common in opioid intoxication?
- Substance use · ApplicationWhat feature suggests alcohol dependence?
- Substance use · ApplicationWhat is the risk of combining opioids with benzodiazepines?
- Substance use · ApplicationWhat feature may indicate opioid withdrawal?
- Substance use · ApplicationWhat is a benefit of motivational interviewing in substance-use care?
- Substance use · ApplicationWhat sign is common in alcohol withdrawal?
- Substance use · ApplicationWhat medication reverses opioid overdose respiratory depression?
- Substance use · ApplicationWhich symptom can occur in alcohol withdrawal?
- Substance use: alcohol withdrawal · Multi-stepA hospitalized patient who stopped heavy alcohol use 48 hours ago is tremulous, diaphoretic, hypertensive, and sees insects crawling on the wall. What is the most appro…
- Substance use: opioid intoxication · ApplicationA drowsy patient has pinpoint pupils, a respiratory rate of 6/min, and oxygen desaturation after taking an unknown tablet. Which immediate antidote is most appropriate…
- Substance use: alcohol withdrawal · Multi-stepA dependent drinker develops agitation, tremor, hypertension and visual hallucinations two days after stopping alcohol. What is first-line pharmacotherapy?
- Substance use: opioids · ApplicationWhich finding is most typical of opioid intoxication?
- Substance use · ApplicationWhat feature suggests alcohol withdrawal delirium?
- Substance use · ApplicationWhat is the first-line medication for opioid overdose with respiratory depression?
Psychopharmacology81
- Psychopharmacology · ApplicationLithium use during the first trimester of pregnancy is associated with which congenital anomaly?
- Psychopharmacology · ApplicationWhich antipsychotic requires regular blood counts because of the risk of agranulocytosis?
- Psychopharmacology · Multi-stepA woman stable on lithium for bipolar disorder is started on a thiazide diuretic for hypertension. A week later she has coarse tremor, vomiting and unsteady gait. What…
- Psychopharmacology · Multi-stepA 24-year-old woman with depression and a history of binge eating and purging asks for a non-sedating, non-sexually-dysfunctional antidepressant. Which drug should be a…
- Psychopharmacology: flumazenil · ApplicationFlumazenil is a competitive antagonist at the benzodiazepine site. Which caution applies to its use?
- Psychopharmacology: benzodiazepines in liver disease · ApplicationA patient with alcoholic cirrhosis needs a benzodiazepine for withdrawal. Which choice is safest because it does not undergo hepatic oxidation?
- Psychopharmacology: buspirone · ApplicationWhich anxiolytic acts as a 5-HT1A partial agonist, lacks sedation and dependence potential, but takes 1 to 2 weeks to work?
- Psychopharmacology: Z-drugs · ApplicationAn elderly man takes zolpidem for insomnia, and his wife reports that he once cooked and ate a meal during the night with no memory of it. This reaction is:
- Psychopharmacology: propranolol uses · ApplicationPropranolol is useful in psychiatry for all of the following EXCEPT:
- Psychopharmacology: anticholinergic toxicity · Multi-stepA patient on trihexyphenidyl and chlorpromazine develops dry mouth, dilated pupils, hot dry skin, urinary retention and confusion. This is best explained by:
- Psychopharmacology: tricyclic antidepressants · ApplicationWhich tricyclic antidepressant is the most selective serotonin reuptake inhibitor and is a standard second-line drug in OCD?
- Psychopharmacology: rapid tranquilisation · ApplicationA violent, agitated patient in the emergency department requires rapid tranquilisation. Which combination is commonly recommended?
- Psychopharmacology: lithium pre-treatment · ApplicationWhich set of investigations is part of the work-up before starting lithium?
- Psychopharmacology: CYP interactions · Multi-stepFluoxetine and paroxetine can raise plasma levels of many tricyclics and impair activation of prodrugs such as codeine and tamoxifen, by inhibiting which enzyme?
- Psychopharmacology: fluvoxamine interaction · Multi-stepA patient stable on clozapine is started on fluvoxamine for OCD and develops sedation, seizures and hypotension. The reason is:
- Psychopharmacology: carbamazepine induction · Multi-stepA woman on carbamazepine for bipolar disorder becomes pregnant while taking the combined oral contraceptive pill. What is the explanation?
- Psychopharmacology: smoking and clozapine · Multi-stepA patient on a stable dose of olanzapine stops smoking after admission to a non-smoking ward and becomes sedated. Why?
- Psychopharmacology: SSRI of choice in cardiac disease · ApplicationIn a patient with depression after a myocardial infarction, which antidepressant has the best safety evidence?
- Psychopharmacology: esketamine · Multi-stepAn intranasal drug used with an oral antidepressant for treatment-resistant depression acts mainly through which mechanism?
- Psychopharmacology: lithium sampling · ApplicationFor monitoring lithium, the blood sample is ideally taken:
- Psychopharmacology: valproate monitoring · ApplicationWhich monitoring is advised in patients on sodium valproate?
- Psychopharmacology: clozapine monitoring · ApplicationDuring the first 18 weeks of clozapine therapy, the absolute neutrophil count is typically monitored:
- Psychopharmacology: benzodiazepine half-life · ApplicationWhich benzodiazepine has the longest elimination half-life because of active metabolites such as desmethyldiazepam?
- Psychopharmacology: acute dystonia versus parkinsonism treatment · ApplicationDrug-induced parkinsonism with tremor and rigidity develops in a patient on a high-potency antipsychotic. Which agent is used for symptomatic relief?
- Psychopharmacology: lithium mechanism · Multi-stepWhich of the following mechanisms has been proposed for the action of lithium?
- Psychopharmacology: NMS treatment · ApplicationA patient on haloperidol develops fever of 40 degrees C, lead-pipe rigidity, sweating, labile blood pressure and a creatine kinase of 12,000 units per litre. Apart from…
- Psychopharmacology: CYP2D6 poor metabolisers · Multi-stepA patient who is a CYP2D6 poor metaboliser develops marked sedation and QT prolongation on a standard dose of nortriptyline. The best explanation is
- Psychopharmacology: benzodiazepines in elderly · ApplicationAn 80-year-old needs short-term treatment for anxiety and insomnia. Why is a long-acting benzodiazepine such as diazepam undesirable?
- Psychopharmacology: lithium and pregnancy counselling · Multi-stepA woman stable on lithium for bipolar I disorder plans pregnancy. What is the best advice?
- Psychopharmacology: anticholinergic misuse · ApplicationA man with schizophrenia on haloperidol repeatedly demands extra tablets of his anti-parkinsonian drug, saying it makes him feel pleasantly high and relaxed, though he…
- Psychopharmacology: lithium and cardiac conduction · Multi-stepA 65-year-old man with bipolar disorder on long-term lithium complains of dizziness and fainting. His ECG shows sinus pauses and T-wave flattening, with a therapeutic l…
- Psychopharmacology: dexmedetomidine for agitation · ApplicationA ventilated ICU patient is agitated and delirious, and the team wants sedation that causes little respiratory depression and leaves the patient rousable. Which drug ac…
- Psychopharmacology: nefazodone hepatotoxicity · ApplicationWhich antidepressant has been withdrawn or restricted in many countries because of rare but fatal hepatic failure?
- Psychopharmacology: aripiprazole and impulse control · ApplicationA 40-year-old man with schizophrenia stable on aripiprazole begins to gamble compulsively, running up large debts and hiding it from his wife. He had no such behaviour…
- Psychopharmacology: benzodiazepines and respiratory disease · Multi-stepA 70-year-old woman with severe COPD and carbon dioxide retention has generalised anxiety disorder. Which drug is the most appropriate for her anxiety?
- Psychopharmacology: low-dose doxepin for insomnia · ApplicationA 55-year-old woman falls asleep easily but wakes repeatedly at 3 am. A drug is chosen that acts mainly through histamine H1 blockade at very low doses and does not cau…
- Psychopharmacology: lithium and leucocytosis · ApplicationA 35-year-old man on lithium for six months has a white cell count of 12,500 per microlitre with normal differential and no fever or infection. What is the correct inte…
- Psychopharmacology: paradoxical reaction to benzodiazepines · ApplicationAn 80-year-old man given diazepam for insomnia during an admission becomes restless, aggressive and disinhibited within an hour. He is not delirious from another cause.…
- Psychopharmacology: lithium in dehydration · ApplicationA 45-year-old woman on lithium develops three days of vomiting and diarrhoea, then coarse tremor, unsteady gait and slurred speech. What is the most appropriate immedia…
- Psychopharmacology: antidepressants and angle-closure glaucoma · Multi-stepA 62-year-old woman with a shallow anterior chamber starts amitriptyline and soon develops a painful red eye with haloes around lights and blurred vision. What is the m…
- Psychopharmacology: treatment of drug-induced parkinsonism · Multi-stepA 70-year-old man on haloperidol develops tremor and rigidity. He has benign prostatic hypertrophy with urinary retention, so an anticholinergic is unsuitable. Which dr…
- Psychopharmacology: antipsychotic weight gain · ApplicationA 30-year-old woman with schizophrenia is stable on olanzapine but has gained 12 kg and has a rising fasting glucose. Besides lifestyle advice, which drug has evidence…
- Psychopharmacology: valproate and hyperammonaemia · Multi-stepA 35-year-old woman on valproate for bipolar disorder becomes lethargic and confused. Liver enzymes are normal, but serum ammonia is markedly raised. What is the likely…
- Psychopharmacology: topiramate adverse effects · Multi-stepA woman receiving an anticonvulsant as an adjunct for mood and binge eating complains of weight loss, paraesthesias, trouble finding words, and flank pain with haematur…
- Psychopharmacology: levetiracetam behavioural effects · ApplicationA patient with epilepsy is started on a new anticonvulsant. Within weeks his family reports irritability, aggression and low mood that were not there before. Which drug…
- Psychopharmacology: efavirenz neuropsychiatric effects · ApplicationA man with HIV starts a first-line antiretroviral regimen and over the next two weeks reports vivid dreams, dizziness, insomnia and low mood. Which component is the mos…
- Psychopharmacology: mefloquine neuropsychiatric toxicity · ApplicationA traveller takes a weekly oral antimalarial for prophylaxis. After the third dose he reports vivid nightmares, anxiety, dizziness and suspicious thoughts about his com…
- Psychopharmacology: cycloserine psychiatric toxicity · ApplicationA patient on a regimen for drug-resistant tuberculosis becomes profoundly depressed with suicidal thoughts and later develops psychosis. Which drug is most likely to be…
- Psychopharmacology: rabbit syndrome · Multi-stepAfter several years of haloperidol, a man develops fast, rhythmic, vertical movements of the lips resembling a rabbit chewing. The tongue is not involved, and the movem…
- Psychopharmacology: lamotrigine and valproate interaction · Multi-stepA patient with bipolar disorder is well controlled on valproate and the clinician plans to add lamotrigine for depressive relapses. How should lamotrigine be dosed?
- Psychopharmacology: St John's wort interactions · Multi-stepA woman on sertraline starts an over-the-counter herbal remedy for low mood. A week later she has agitation, sweating, tremor, diarrhoea and hyperreflexia. Which herbal…
- Psychopharmacology: psychodrama · ApplicationIn a group session a patient is asked to act out a painful confrontation with her mother, while other members take the roles of mother and sibling under the therapist's…
- Psychopharmacology: contingency management · ApplicationA drug treatment clinic gives patients vouchers of rising value for each urine sample that is negative for illicit drugs, and withholds them after a positive sample. Wh…
- Psychopharmacology: lithium and the parathyroid · ApplicationA woman on lithium for bipolar disorder for eight years has constipation, polyuria and a serum calcium that is above the normal range with a raised parathyroid hormone.…
- Psychopharmacology: lamotrigine and oestrogen contraceptives · Multi-stepA woman with bipolar disorder is stable on lamotrigine. After starting a combined oral contraceptive pill she has a breakthrough depressive relapse. What is the likely…
- Psychopharmacology: hypotension caused by chlorpromazine · Multi-stepA patient on chlorpromazine collapses with severe hypotension and needs a vasopressor. Which agent is appropriate, and which should be avoided?
- Psychopharmacology: dopamine receptor occupancy · Multi-stepImaging studies relate antipsychotic response and side effects to D2 receptor occupancy. Which statement is correct?
- Psychopharmacology: antipsychotic choice in Parkinson disease · ApplicationA 72-year-old man with Parkinson disease develops troublesome visual hallucinations after dopaminergic treatment. If an antipsychotic is needed, which choice is least l…
- Psychopharmacology: parenteral olanzapine with benzodiazepine · Multi-stepAn agitated patient has been given intramuscular olanzapine. The nurse proposes an immediate intramuscular lorazepam injection for continued agitation. What is the conc…
- Psychopharmacology: managing risperidone hyperprolactinaemia · ApplicationA woman with schizophrenia stable on risperidone has galactorrhoea, amenorrhoea and a raised prolactin. Her psychosis is controlled. Which change is most suitable?
- Psychopharmacology: SSRI exposure late in pregnancy · ApplicationA woman took an SSRI throughout pregnancy. Her newborn develops tachypnoea and cyanosis with a loud second heart sound, and echocardiography shows raised pulmonary pres…
- Psychopharmacology: SSRI associated with QT prolongation · ApplicationA 68-year-old with depression is to start an SSRI, but she has a long QT interval on her ECG. Which SSRI carries a dose-dependent warning for QT prolongation and should…
- Psychopharmacology: opioid to avoid with MAOI · ApplicationA patient on phenelzine needs postoperative analgesia. Which opioid is particularly dangerous because of a severe interaction with MAOIs?
- Psychopharmacology: antidepressant-induced switch in bipolar disorder · ApplicationA man with bipolar II disorder on fluoxetine alone becomes elated, sleeps little and has pressured speech within three weeks of starting it. What is the most appropriat…
- Psychopharmacology: GABA-A subunit and sedation · Multi-stepBenzodiazepine effects are mediated by different alpha subunits of the GABA-A receptor. Which subunit is mainly responsible for sedation?
- Psychopharmacology · ApplicationWhat adverse effect should be considered with many antipsychotics?
- Psychopharmacology · ApplicationWhat adverse effect may develop with selective serotonin reuptake inhibitors early in treatment?
- Psychopharmacology · ApplicationWhat potentially life-threatening syndrome can follow dopamine blockade with fever and rigidity?
- Psychopharmacology · ApplicationWhat adverse effect warrants monitoring with lithium therapy?
- Psychopharmacology · ApplicationWhat syndrome may result from excess serotonergic medication effects?
- Psychopharmacology · ApplicationWhat adverse effect can occur with dopamine-blocking antipsychotics?
- Psychopharmacology · ApplicationWhat blood test is required during clozapine therapy?
- Psychopharmacology · ApplicationWhich adverse effect is classically linked to antipsychotic dopamine blockade?
- Psychopharmacology · ApplicationWhich syndrome is a medical emergency after antipsychotic use?
- Psychopharmacology: serotonin syndrome · Multi-stepSoon after adding linezolid to an SSRI, a patient develops agitation, fever, diaphoresis, diarrhea, inducible clonus, and hyperreflexia. What is the most likely diagnos…
- Psychopharmacology: lithium toxicity · Multi-stepA patient stable on lithium develops vomiting, coarse tremor, ataxia, and confusion after starting a thiazide diuretic. What is the best explanation?
- Psychopharmacology: valproate · ApplicationWhich pre-treatment issue is especially important before prescribing valproate to a person who could become pregnant?
- Psychopharmacology: antipsychotic adverse effects · ApplicationSeveral months after receiving a dopamine-blocking antipsychotic, a patient develops repetitive lip smacking and choreiform tongue movements. What is the most likely ad…
- Psychopharmacology: valproate · ApplicationWhich counselling point is essential before prescribing valproate to a person who may become pregnant?
- Psychopharmacology · ApplicationWhat adverse effect requires urgent review in a patient taking clozapine?
- Psychopharmacology · ApplicationWhich adverse effect is associated with long-term antipsychotic use?
Mood disorders65
- Mood disorders: ICD-10 core symptoms · ApplicationWhich of the following is NOT one of the three core symptoms of a depressive episode in ICD-10?
- Mood disorders: mania · ApplicationA 28-year-old sleeps 2 hours a night, spends lavishly, speaks rapidly and feels he has special powers. Symptoms have lasted 10 days. The diagnosis is:
- Mood disorders: hypomania · ApplicationIn DSM-5, hypomania must last at least how many days?
- Mood disorders: cyclothymia · ApplicationFor a diagnosis of cyclothymic disorder in an adult, numerous periods of hypomanic and depressive symptoms must be present for at least:
- Mood disorders: rapid cycling · Multi-stepIn DSM-5, the 'with rapid cycling' specifier for bipolar disorder requires at least how many mood episodes in a 12-month period?
- Mood disorders: seasonal pattern · ApplicationA woman has depression every winter with hypersomnia, carbohydrate craving and weight gain, remitting in spring. Which treatment is specifically effective?
- Mood disorders: atypical depression · Multi-stepA 25-year-old has depression with reactive mood, hypersomnia, increased appetite, heaviness of the limbs and marked sensitivity to rejection. Which drug class has histo…
- Mood disorders: melancholia · ApplicationA depressed patient wakes at 3 am, feels worst in the morning, has marked weight loss and psychomotor retardation, and shows no mood reactivity. This pattern is:
- Mood disorders: post-stroke depression · Multi-stepDepression after stroke is classically associated with the lesion being located in the
- Mood disorders: psychotic depression treatment · Multi-stepA 58-year-old woman with severe depression, delusions of guilt and refusal of food is losing weight rapidly. Which is the most effective treatment option?
- Mood disorders: mixed features specifier · ApplicationA patient meeting criteria for a major depressive episode also has elevated mood, grandiosity and decreased need for sleep during the same weeks, though not enough for…
- Mood disorders: bipolar II disorder · ApplicationUsing DSM-5 criteria, a woman has had two major depressive episodes and one four-day period of elevated energy, reduced need for sleep and talkativeness that was notice…
- Mood disorders: Cushing syndrome and depression · ApplicationA patient with new depression, central obesity, striae, hypertension and proximal muscle weakness most likely has psychiatric symptoms caused by
- Mood disorders: treatment-resistant depression · Multi-stepA patient with major depression has not responded to adequate trials of two antidepressants of different classes. Which is an evidence-based next step?
- Mood disorders: vagus nerve stimulation · ApplicationWhich neuromodulation method uses a surgically implanted pulse generator in the chest wall, wired to the left vagus nerve in the neck, and is approved for treatment-res…
- Mood disorders: bereavement versus depression · ApplicationWhich feature points to major depression rather than normal grief in a recently bereaved person?
- Mood disorders: mania and hypomania differentiation · ApplicationWhich feature distinguishes mania from hypomania?
- Mood disorders: lithium in acute mania onset · Multi-stepA manic patient on lithium alone is still agitated after four days, with a serum level of 0.8 mEq per litre. The most appropriate next step is
- Mood disorders: secondary mania after stroke · Multi-stepA 66-year-old man with no psychiatric history becomes elated, sleeps three hours a night, spends recklessly and talks incessantly three weeks after a right-hemisphere i…
- Mood disorders: reduced need for sleep versus insomnia · Multi-stepTwo patients report sleeping four hours a night for a week. Patient A is exhausted all day and keeps trying to sleep. Patient B feels energetic, starts new projects and…
- Mood disorders: irritability in adolescent depression · ApplicationA 15-year-old has become sulky, short-tempered and withdrawn for two months, with falling grades, headaches and abdominal pains, and says he feels fine. By DSM-5, which…
- Mood disorders: Socratic questioning in cognitive therapy · ApplicationA depressed woman says, 'Everyone at work thinks I am useless.' Her therapist asks, 'What evidence do you have for that, and what evidence goes against it?' Which techn…
- Mood disorders: Mood Disorder Questionnaire · ApplicationA clinician wants a screening questionnaire to detect past manic or hypomanic episodes in a patient being treated for recurrent depression. Which instrument is designed…
- Mood disorders: monoamine hypothesis and reserpine · ApplicationA man started on reserpine for hypertension becomes withdrawn, tearful and sleepless over several weeks. Which mechanism of the drug explains the depression?
- Mood disorders: drug-induced depression · ApplicationA 17-year-old on treatment for severe nodulocystic acne develops low mood, irritability and passive thoughts of death over two months. Which drug is the most likely con…
- Mood disorders: delirious mania · Multi-stepA 27-year-old man with bipolar disorder is brought with a week of extreme overactivity, insomnia and pressured speech. He is now disoriented, drowsy at times, and sees…
- Mood disorders: kindling in bipolar disorder · ApplicationIn bipolar disorder, successive episodes tend to come closer together and later ones occur without any stressor. Which hypothesis explains this?
- Mood disorders: pseudobulbar affect · Multi-stepA 66-year-old man after a stroke has sudden, uncontrollable bouts of crying that last under a minute, set off by trivial events. Between bouts he denies sadness, and sl…
- Mood disorders: curriculum recognition · ApplicationA depressed patient who takes no medication has markedly slowed speech, long delays before answering and reduced spontaneous movement, but responds appropriately and sh…
- Mood disorders: curriculum recognition · ApplicationA patient abruptly stops paroxetine and within two days has dizziness, electric-shock sensations, nausea, irritability and flu-like symptoms. What is the diagnosis?
- Mood disorders: vascular depression · Multi-stepA 72-year-old hypertensive man has a first depressive episode with marked apathy, psychomotor slowing, poor executive function and little guilt. MRI shows extensive per…
- Mood disorders: late-onset mania · Multi-stepA 64-year-old man with no previous psychiatric illness and no family history is brought with two weeks of elevated, irritable mood, reduced sleep and new disorientation…
- Mood disorders: double depression · ApplicationA 38-year-old woman reports low mood on most days for four years, never free of it for more than two months. Over the last three weeks she has developed severe insomnia…
- Mood disorders: TRH stimulation test · Multi-stepNeuroendocrine tests are performed in patients with major depression. After an intravenous dose of thyrotropin-releasing hormone, which result is reported in a substant…
- Mood disorders: mindfulness-based cognitive therapy · ApplicationA 45-year-old woman has had three depressive episodes and is now in remission off medication. She wants a non-drug approach to lower her chance of relapse. Which struct…
- Mood disorders: antidepressants in young patients · ApplicationWhen an SSRI is started for depression, which group needs particularly close monitoring in the first weeks for emerging suicidal thoughts?
- Mood disorders: mild lithium toxicity · Multi-stepA man on long-term lithium has had severe diarrhoea and vomiting for two days. He has nausea, coarse tremor and mild unsteadiness, is alert, and his serum lithium is 1.…
- Mood disorders: lithium-induced hypothyroidism · ApplicationA woman on lithium for bipolar I disorder for three years develops fatigue, weight gain and cold intolerance. Serum TSH is raised and free T4 is low, and her mood is st…
- Mood disorders: lithium tremor · ApplicationA man stable on lithium with a serum level of 0.7 mmol/L has a fine postural tremor of both hands that interferes with writing. There are no other toxic features. What…
- Mood disorders: stopping lithium · ApplicationA man with bipolar I disorder has been stable on lithium for five years and wishes to stop it overnight because he feels well. What is the main risk of abrupt discontin…
- Mood disorders: ECT in pregnancy · Multi-stepA woman in the second trimester of pregnancy has severe psychotic depression with refusal of food and fluids and active suicidal intent. Medicines carry concerns and sh…
- Mood disorders: switching from fluoxetine to an MAOI · ApplicationA patient with depression has not responded to fluoxetine and the doctor wishes to start an irreversible MAOI. Why must a long washout of several weeks be left after st…
- Mood disorders: tricyclic choice in elderly · ApplicationA frail 72-year-old with depression has marked postural hypotension and a history of falls. A tricyclic is considered because other drugs failed. Which tricyclic is rel…
- Mood disorders: delay in antidepressant action · ApplicationAntidepressants raise synaptic monoamine levels within hours, yet clinical benefit takes two to four weeks. Which explanation is most widely proposed for this delay?
- Mood disorders: relapse after ECT · ApplicationA man with severe melancholic depression recovers fully after a course of ECT. What is the best way to reduce his risk of early relapse?
- Mood disorders: lithium response predictors · ApplicationWhich patient with bipolar disorder is most likely to respond well to lithium prophylaxis?
- Mood disorders: sleep deprivation · ApplicationA hospitalised patient with severe depression shows a brief, rapid improvement in mood the morning after a night of total sleep deprivation, but the effect is lost afte…
- Mood disorders: Freudian view of melancholia · ApplicationIn 'Mourning and Melancholia', Freud explained pathological depression as the result of which process?
- Mood disorders: mood stabiliser in renal impairment · ApplicationA 48-year-old man with bipolar I disorder has stage 4 chronic kidney disease with a markedly reduced glomerular filtration rate. He needs a mood stabiliser for long-ter…
- Mood disorders · ApplicationWhat feature is characteristic of a manic episode?
- Mood disorders · ApplicationWhat symptom is central to major depressive disorder?
- Mood disorders · ApplicationWhat symptom distinguishes mania from ordinary happiness?
- Mood disorders · ApplicationWhich symptom describes a markedly reduced ability to enjoy previously rewarding activities?
- Mood disorders · ApplicationWhat safety issue must be routinely assessed in severe depression?
- Mood disorders · ApplicationWhat symptom is characteristic of hypomania?
- Mood disorders · ApplicationWhat is psychomotor retardation?
- Mood disorders · ApplicationWhat is important before starting an antidepressant in possible bipolar disorder?
- Mood disorders · ApplicationWhat symptom is central to a major depressive episode?
- Mood disorders · ApplicationWhat behavior is particularly concerning in mania?
- Mood disorders · ApplicationWhich symptom is required for major depressive episode diagnosis?
- Mood disorders: mania · ApplicationA patient has elevated mood, grandiosity, reduced need for sleep and risky spending for 10 days with marked functional impairment. What is the most likely episode?
- Mood disorders: bipolar depression · ApplicationWhy should antidepressant monotherapy be used cautiously in bipolar I depression?
- Mood disorders · ApplicationWhat duration is required for a major depressive episode diagnosis?
- Mood disorders · ApplicationWhich symptom is most characteristic of mania?
- Mood disorders · ApplicationWhat distinguishes bipolar II disorder from bipolar I disorder?
Psychotic disorders48
- Psychotic disorders · ApplicationWhich of the following is a Schneiderian first-rank symptom of schizophrenia?
- Psychotic disorders · ApplicationA 40-year-old unmarried woman firmly believes that a famous film director is secretly in love with her and sends her coded messages. She works well and has no hallucina…
- Psychotic disorders · Multi-stepA 22-year-old man has had hallucinations, delusions of persecution and disorganised speech with social withdrawal for the last 3 months, with a steady decline in functi…
- Psychotic disorders: brief psychotic disorder · ApplicationAfter the sudden death of her son, a 40-year-old woman develops hallucinations and disorganised speech lasting 10 days, then recovers completely. The DSM-5 diagnosis is:
- Psychotic disorders: schizoaffective disorder · Multi-stepA patient has a major depressive episode with hallucinations, and for at least 2 weeks has delusions and hallucinations while his mood is normal. Mood symptoms are pres…
- Psychotic disorders: acute and transient psychosis · ApplicationA 28-year-old develops hallucinations, delusions and perplexity over 5 days, which resolve fully within 6 weeks. The ICD-10 category that best fits is:
- Psychotic disorders: induced delusional disorder · ApplicationA woman begins to believe her neighbours are plotting against her after living with her sister, who has a persecutory delusional disorder. The two are socially isolated…
- Psychotic disorders: first-episode psychosis duration of untreated psychosis · Multi-stepA longer duration of untreated psychosis in first-episode schizophrenia is associated with
- Psychotic disorders: first-episode antipsychotic duration · ApplicationAfter a first episode of schizophrenia with good remission, antipsychotic treatment is usually continued for at least
- Psychotic disorders: negative symptoms treatment · Multi-stepProminent negative symptoms with minimal positive symptoms in a stable patient on an antipsychotic. Which approach has the best support?
- Psychotic disorders: shared psychotic disorder management · ApplicationA woman develops the same delusion of being poisoned as her dominant, psychotic husband with whom she lives in isolation. What is the first step in management?
- Psychotic disorders: delusion of control · ApplicationA patient says, 'An electric machine in the next building makes me raise my arm; it is not my own will.' This is
- Psychotic disorders: thought withdrawal · ApplicationA patient says, 'My thoughts are suddenly taken out of my head by someone, leaving it empty.' This experience is
- Psychotic disorders: late paraphrenia and hearing loss · Multi-stepA 72-year-old woman living alone with severe hearing loss develops well-organised persecutory delusions and voices commenting on her. She has no cognitive impairment. W…
- Psychotic disorders: 22q11.2 deletion and psychosis · Multi-stepA 19-year-old with a first psychotic episode had cleft palate repair in infancy, a congenital heart defect, recurrent infections, hypocalcaemia in childhood, hypernasal…
- Psychotic disorders: ECT in lorazepam-resistant catatonia · ApplicationA 25-year-old woman with schizophrenia is mute, immobile and refusing food for six days, with negativism and posturing. Three days of lorazepam at adequate doses have b…
- Psychotic disorders: mortality in schizophrenia · ApplicationA public-health team reviews deaths in people with schizophrenia, who live 10 to 20 years less than the general population. Which cause accounts for the largest number…
- Psychotic disorders: post-injection delirium sedation syndrome · Multi-stepA 35-year-old man receives his first long-acting olanzapine depot injection. Two hours later he is drowsy, confused, ataxic and dysarthric, and then has a brief convuls…
- Psychotic disorders: depressive stupor versus catatonia · Multi-stepA 52-year-old woman is mute and barely moves, after weeks of low mood, early waking and weight loss. On examination she has a sad facial expression and tearful eyes, bu…
- Psychotic disorders: musical hallucinations · ApplicationA 78-year-old woman with long-standing bilateral hearing loss hears hymns and old film songs playing in the house, mostly at night. She knows the music is not real, and…
- Psychotic disorders: first psychosis with seizures in India · Multi-stepA 26-year-old farmer from a village where pigs roam freely has had two generalised seizures in the last month, followed by three weeks of hearing voices and suspiciousn…
- Psychotic disorders: duration of an adequate antipsychotic trial · ApplicationA 21-year-old with first-episode schizophrenia has taken risperidone 4 mg daily for ten days with partial improvement and mild akathisia. His family asks to change the…
- Psychotic disorders: first-episode psychosis with a substance trigger and safe next step · Multi-stepA 19-year-old is brought with three days of fearfulness, hearing voices and refusing to eat, with an elevated pulse and dilated pupils. His friends say he took an unkno…
- Psychotic disorders: assertive community treatment · ApplicationA 29-year-old man with schizophrenia lives alone far from the hospital. He repeatedly stops medication, misses clinic visits and is readmitted every few months. Which s…
- Psychotic disorders: psychogenic polydipsia · Multi-stepA 40-year-old man with chronic schizophrenia drinks about 8 litres of water daily. He is brought with confusion and a generalised seizure. Serum sodium is 118 mmol/L an…
- Psychotic disorders: Lilliputian hallucination · ApplicationOn the third day after stopping heavy drinking, a man is agitated and tells the nurse that dozens of tiny people are marching across his bedsheet. He finds them amusing…
- Psychotic disorders: autoscopic hallucination · Multi-stepA man with temporal lobe epilepsy says that, during some spells, he sees a complete image of himself standing a few metres away that copies his movements. He knows the…
- Psychotic disorders: gegenhalten · Multi-stepA mute, rigid patient with catatonic schizophrenia is examined. When the examiner tries to bend his elbow, he resists with a force exactly matching the force applied, w…
- Psychotic disorders: ambitendency · Multi-stepA catatonic patient is offered a handshake. He starts to raise his hand, pulls it back, starts again, and repeats this hesitant sequence without ever completing the act…
- Psychotic disorders: smooth pursuit eye movements · ApplicationA research team studies oculomotor tasks as a possible endophenotype of schizophrenia. Patients and some of their unaffected first-degree relatives are asked to follow…
- Psychotic disorders: double orientation · Multi-stepA man with chronic schizophrenia firmly believes he is secretly the head of the intelligence service. Yet he arrives on time for his clerical job, does it competently,…
- Psychotic disorders: sensorimotor gating deficit · ApplicationIn a laboratory test, a weak sound just before a loud sound normally dampens the startle reflex to the loud sound. What is the typical finding when the test is done in…
- Psychotic disorders: neurodevelopmental hypothesis evidence · ApplicationPost-mortem studies of patients with schizophrenia show reduced cortical and hippocampal volume. Which accompanying finding best supports a neurodevelopmental rather th…
- Psychotic disorders: suicide risk in schizophrenia · Multi-stepA psychiatrist ranks four patients with schizophrenia for suicide risk. Which patient is at highest risk?
- Psychotic disorders: engaging a patient with delusional disorder · ApplicationA 45-year-old businessman is firmly convinced that his neighbours are conspiring to harm him. He is otherwise well-organised, has no hallucinations, and refuses medicin…
- Psychotic disorders: restarting clozapine after missed doses · ApplicationA man stable on clozapine 400 mg daily had to stop it when he was admitted to a general hospital, and has now missed all doses for four days. What is the safest way to…
- Psychotic disorders: clozapine and carbamazepine · ApplicationA patient with treatment-resistant schizophrenia on clozapine develops generalised seizures. A colleague suggests adding an anticonvulsant that is also a mood stabilise…
- Psychotic disorders: hypofrontality · ApplicationA functional imaging study asks patients with schizophrenia and healthy controls to perform a card-sorting task that needs set shifting. Which finding is typical in the…
- Psychotic disorders: antipsychotic potency and receptor · ApplicationWhen the daily clinical doses of conventional antipsychotics are compared with their binding properties, the dose needed correlates most closely with the affinity of th…
- Psychotic disorders: forced normalisation · Multi-stepA man with long-standing temporal lobe epilepsy has his seizures controlled with a new anticonvulsant, and his EEG becomes normal. Within weeks he becomes suspicious, h…
- Psychotic disorders: secondary negative symptoms · Multi-stepA man with chronic schizophrenia on haloperidol appears expressionless, moves little and speaks rarely. He has cogwheel rigidity and a resting tremor, and his hallucina…
- Psychotic disorders: DSM-5 criterion A · ApplicationAccording to DSM-5, schizophrenia needs two or more characteristic symptoms for a significant part of one month, and at least one must be from a specific group. Which p…
- Psychotic disorders: determinants of functional outcome · ApplicationA patient's psychotic symptoms have remitted on treatment, yet he remains unable to hold a job. Which domain of schizophrenia is the strongest predictor of this poor ev…
- Psychotic disorders: delusional mood · ApplicationIn the weeks before his first psychotic breakdown, a young man feels that something ominous and uncanny is about to happen and that the world has changed, but he cannot…
- Psychotic disorders: social skills training · ApplicationA stable man with schizophrenia has few remaining positive symptoms but cannot start conversations, express needs or manage a job interview. Which psychosocial interven…
- Psychotic disorders · ApplicationWhich is a positive symptom of schizophrenia?
- Psychotic disorders: delusional disorder · ApplicationFor 18 months, a patient has a fixed belief that a neighbour is contaminating his water. Apart from this, functioning and behaviour are relatively preserved and there a…
- Psychotic disorders: schizoaffective disorder · Multi-stepA patient has recurrent manic episodes and psychosis. On one occasion, delusions persisted for three weeks after all mood symptoms had remitted. Which diagnosis is most…
Organic mental disorders44
- Organic mental disorders: neuropsychiatric lupus · Multi-stepA 24-year-old woman develops a malar rash, joint pains and oral ulcers over two months, and then sudden psychosis with a generalised seizure. Which investigation best s…
- Organic mental disorders: CSF biomarkers in Alzheimer disease · ApplicationA 68-year-old woman has progressive memory loss over two years. A lumbar puncture is done to support the diagnosis of Alzheimer disease. Which CSF pattern is typical?
- Organic mental disorders: akinetic mutism · Multi-stepAfter an anterior cerebral artery infarct, a 60-year-old man lies with eyes open, tracks the examiner with his gaze, but does not speak or move spontaneously. He respon…
- Organic mental disorders: anti-LGI1 limbic encephalitis · Multi-stepA 62-year-old man has brief, frequent jerks of the face and arm for several weeks, followed by memory loss and confusion. Serum sodium is 124 mmol/L. Which antibody is…
- Organic mental disorders: procedural memory · ApplicationAfter bilateral medial temporal lobe resection, a patient cannot remember any event since surgery, yet over several days his speed on a mirror-drawing task steadily imp…
- Organic mental disorders: ideomotor apraxia · Multi-stepAfter a left parietal infarct, a man with full strength cannot pretend to comb his hair when asked, but combs it normally while getting dressed. He knows what a comb is…
- Organic mental disorders: FDG-PET in frontotemporal dementia · Multi-stepA 62-year-old man has disinhibition, hyperorality, loss of empathy and apathy for two years, while his memory and navigation remain relatively intact. Which FDG-PET fin…
- Organic mental disorders: Hindi Mental State Examination · ApplicationA geriatric psychiatrist in northern India needs to screen a 72-year-old man who has never attended school and speaks only Hindi. Which tool is the most suitable cognit…
- Organic mental disorders: uncinate seizures · Multi-stepA 35-year-old woman has episodes lasting a minute in which she smells burning rubber, then stares, smacks her lips and does not respond. Where is the most likely site o…
- Organic mental disorders: apathetic hyperthyroidism · Multi-stepA 75-year-old woman has lost weight, is withdrawn and apathetic, and has mild confusion and new atrial fibrillation. She has no tremor, heat intolerance or goitre. Whic…
- Organic mental disorders: Stroop test · ApplicationIn a neuropsychological test, a patient must name the ink colour of printed colour words, where the word spells a different colour, for example the word red printed in…
- Organic mental disorders: catastrophic reaction · ApplicationA 72-year-old man with dementia is asked to copy a drawing. Unable to do it, he suddenly becomes tearful, shouts and throws the paper. Soon afterward he is calm. What i…
- Organic mental disorders: anticholinergic delirium in the elderly · ApplicationA 78-year-old man with depression started a tricyclic antidepressant and develops constipation, urinary retention and acute confusion. Which drug is the likely cause?
- Organic mental disorders: subcortical vascular dementia · Multi-stepA 68-year-old man with long-standing poorly controlled hypertension has slow thinking, apathy, shuffling gait and urinary urgency over three years. MRI shows extensive…
- Organic mental disorders: Hachinski ischaemic score · ApplicationA bedside scale uses abrupt onset, stepwise deterioration, fluctuating course, history of hypertension, history of strokes and focal neurological signs to help separate…
- Organic mental disorders: dopamine transporter imaging · Multi-stepA 70-year-old man has fluctuating cognition, well-formed visual hallucinations, acting out of dreams and mild parkinsonism. Which imaging finding would best support the…
- Organic mental disorders: neurochemistry of delirium · Multi-stepAn 80-year-old develops delirium after being given a drug with strong anticholinergic activity. Which neurochemical imbalance is considered central to delirium?
- Organic mental disorders: postictal psychosis · Multi-stepA 35-year-old man with long-standing temporal lobe epilepsy has a cluster of seizures. He appears normal for about a day, then becomes paranoid with religious preoccupa…
- Organic mental disorders: Hashimoto encephalopathy · Multi-stepA 40-year-old woman has subacute confusion, visual hallucinations, tremor, myoclonus and a seizure. Thyroid function is near normal, anti-thyroid peroxidase antibodies…
- Organic mental disorders: prevention of delirium · ApplicationAn 80-year-old woman is admitted after a hip fracture and is at high risk of delirium. Which strategy best lowers the chance of delirium?
- Organic mental disorders: Parkinson disease dementia treatment · ApplicationA 74-year-old man with Parkinson disease for eight years develops progressive cognitive decline, fluctuating attention and visual hallucinations. Which drug is licensed…
- Organic mental disorders: CADASIL · Multi-stepA 45-year-old woman has migraine with aura, recurrent lacunar strokes, mood disturbance and progressive cognitive decline. Her mother had similar problems. MRI shows wh…
- Organic mental disorders: Huntington disease imaging · ApplicationA 38-year-old man has irritability, depression, clumsiness and involuntary dance-like movements. His father died in an institution with a similar illness. Which neuroim…
- Organic mental disorders: Wilson disease · ApplicationAn 18-year-old has declining school performance, depression, dysarthria, tremor and abnormal liver enzymes. Which examination finding would best support the suspected d…
- Organic mental disorders: forced normalisation · Multi-stepA man with refractory temporal lobe epilepsy becomes seizure-free after an anticonvulsant is added. Within weeks he becomes paranoid and hears voices, and an EEG now sh…
- Organic mental disorders: Balint syndrome · Multi-stepAfter bilateral parieto-occipital infarcts, a 66-year-old man can see only one object at a time in a scene, misreaches when trying to grasp an object under visual guida…
- Organic mental disorders: Anton syndrome · Multi-stepA 68-year-old man after bilateral occipital infarcts walks into furniture but insists that he can see. He describes his surroundings fluently and wrongly. Pupillary lig…
- Organic mental disorders: prosopagnosia · ApplicationAfter a stroke, a 60-year-old woman cannot recognise her husband's face or her own face in a mirror, though she knows him at once when he speaks. Her visual acuity is n…
- Organic mental disorders: conduction aphasia · Multi-stepA 58-year-old man after a left parietal infarct speaks fluently with phonemic errors, understands commands well, but cannot repeat the sentence 'No ifs, ands or buts'.…
- Organic mental disorders: alexia without agraphia · Multi-stepA 70-year-old man after a left posterior cerebral artery infarct has a right homonymous hemianopia. He can write sentences and speak normally, but cannot read what he h…
- Organic mental disorders: transient global amnesia · ApplicationA 62-year-old man suddenly begins repeating the same questions about where he is and what is happening. He knows his name and recognises his wife, has no other neurolog…
- Organic mental disorders: EEG in hepatic encephalopathy · ApplicationA cirrhotic patient is drowsy and disoriented, with flapping tremor of the outstretched hands. Which EEG finding is characteristic of this metabolic encephalopathy?
- Organic mental disorders: hypercalcaemia · ApplicationA 55-year-old woman has fatigue, constipation, low mood and impaired concentration. She also reports polyuria and a past renal stone. Which metabolic abnormality should…
- Organic mental disorders: progressive supranuclear palsy · Multi-stepA 68-year-old man has frequent unexplained falls backwards, difficulty looking downwards, a stiff neck and trunk, apathy and slowed thinking. Levodopa gives little bene…
- Organic mental disorders: corticobasal degeneration · Multi-stepA 65-year-old woman has progressive clumsiness of the right hand, which feels foreign and sometimes moves on its own. She also has asymmetric rigidity, apraxia and myoc…
- Organic mental disorders: semantic variant primary progressive aphasia · Multi-stepA 62-year-old man has progressive loss of the meaning of words. He speaks fluently but uses vague terms, cannot name objects and asks what 'pheasant' means. Repetition…
- Organic mental disorders: chronic subdural haematoma · ApplicationA 74-year-old man with chronic alcohol use fell two months ago. He now has several weeks of increasing drowsiness, headache and confusion with mild left-sided weakness.…
- Organic mental disorders: herpes simplex encephalitis · ApplicationA 40-year-old woman has 3 days of fever, headache and sudden personality change, with olfactory hallucinations and a focal seizure. CSF shows lymphocytes and red cells,…
- Organic mental disorders: carbon monoxide poisoning sequelae · ApplicationA man recovers fully after carbon monoxide poisoning, but two weeks later he becomes apathetic, forgetful and parkinsonian. MRI shows symmetric lesions in a deep grey n…
- Organic mental disorders: olfactory groove meningioma · Multi-stepA 55-year-old woman has several months of apathy, disinhibited remarks and loss of the sense of smell. Fundoscopy shows optic atrophy in the right eye and papilloedema…
- Organic mental disorders: mild versus major neurocognitive disorder · ApplicationA 70-year-old retired teacher notices memory decline and neuropsychological testing shows a modest decline in memory. She still manages her finances and medicines indep…
- Organic mental disorders: utilisation behaviour · Multi-stepA 60-year-old man with a large frontal lobe lesion picks up a pen and begins writing when it is placed in front of him, and puts on spectacles placed on the table even…
- Organic mental disorders: cortical versus subcortical dementia · ApplicationA 58-year-old man with Huntington disease has marked slowing of thought, apathy, impaired retrieval of memories and difficulty planning, but no aphasia, apraxia or agno…
- Organic mental disorders: chronic traumatic encephalopathy · ApplicationA 55-year-old retired professional boxer develops progressive memory loss, slurred speech, parkinsonism, irritability and paranoia. Which pathology is characteristic of…
Child and adolescent psychiatry34
- Child and adolescent psychiatry: comprehensive behavioural intervention for tics · ApplicationA 9-year-old boy with Tourette disorder has frequent motor and vocal tics which he can feel coming on as an uncomfortable urge, and which cause teasing at school. His p…
- Child and adolescent psychiatry: inattention versus absence seizures · Multi-stepAn 8-year-old is labelled inattentive because of daily spells in which he stares blankly for about ten seconds, with brief eyelid flutter, and then resumes the activity…
- Child and adolescent psychiatry: non-suicidal self-injury · ApplicationA 15-year-old girl cuts her forearms with a blade after arguments, saying it relieves the unbearable tension and she has no wish to die. What is the most common functio…
- Child and adolescent psychiatry: social communication disorder · Multi-stepA 7-year-old has fluent speech and a large vocabulary, but does not adapt his language to the listener, cannot follow the rules of conversation or understand jokes and…
- Child and adolescent psychiatry: anaclitic depression · ApplicationA 9-month-old infant in an orphanage, separated from his mother for three months, is apathetic, weeps quietly, has lost weight and shows developmental regression. Which…
- Child and adolescent psychiatry: social learning theory · ApplicationAfter watching an adult punch and kick an inflatable doll, children later imitate the same aggressive acts when left alone with the doll. Which theory does this support?
- Child and adolescent psychiatry: Lesch-Nyhan syndrome · ApplicationA 3-year-old boy has developmental delay, dystonia and choreoathetosis, and repeatedly bites his lips and fingers. His diapers show orange crystals and serum uric acid…
- Child and adolescent psychiatry: Prader-Willi syndrome · ApplicationA child had marked hypotonia and poor feeding as an infant. At 5 years he has insatiable hunger, obesity, mild intellectual disability, hypogonadism, temper outbursts a…
- Child and adolescent psychiatry: parent management training · ApplicationAn 8-year-old boy is defiant, argumentative and loses his temper with adults at home and school but has not violated others' rights or broken laws. Which intervention i…
- Child and adolescent psychiatry: temperament types · Multi-stepAn infant has irregular sleeping and feeding, cries loudly and intensely, reacts strongly and negatively to new foods and strangers, and takes a long time to adapt to c…
- Child and adolescent psychiatry: Angelman syndrome · ApplicationA 3-year-old has severe intellectual disability, absent speech, a jerky ataxic gait, seizures, microcephaly and frequent bursts of unprovoked laughter with a happy deme…
- Child and adolescent psychiatry: Williams syndrome · ApplicationA 6-year-old has elfin facies, is very friendly with strangers, speaks fluently, but has poor visuospatial skills and mild intellectual disability. Echocardiography sho…
- Child and adolescent psychiatry: fragile X syndrome · ApplicationA 6-year-old boy has intellectual disability, a long face, large ears, flat feet and hand-flapping with poor eye contact. His maternal uncle has similar problems. What…
- Child and adolescent psychiatry: calculating ratio IQ · ApplicationAn 8-year-old child is found to have a mental age of 6 years on a standardised test. What is the ratio IQ?
- Child and adolescent psychiatry: preventing intellectual disability in phenylketonuria · ApplicationA fair-skinned infant has a musty body odour and vomiting, and the newborn screen shows raised phenylalanine. Which intervention started early prevents intellectual dis…
- Child and adolescent psychiatry: structured observation in autism · ApplicationIn a child suspected of autism, a clinician uses a semi-structured, standardised play-based assessment with social tasks to observe communication and social behaviour.…
- Child and adolescent psychiatry: core intervention for autism · ApplicationParents of a 3-year-old with newly diagnosed autism ask which treatment improves the core social and communication difficulties. What is the best approach?
- Child and adolescent psychiatry: ADHD in preschool children · ApplicationA 4-year-old girl is very overactive and impulsive at home and in nursery for over a year, with significant impairment. Which treatment should be tried first?
- Child and adolescent psychiatry: adverse effects of methylphenidate · ApplicationAn 8-year-old boy has done well on methylphenidate for three months but now eats little at lunch and takes a long time to fall asleep. What explains these effects?
- Child and adolescent psychiatry: atomoxetine warning · ApplicationWhich boxed warning applies to atomoxetine, used for ADHD in children and adolescents?
- Child and adolescent psychiatry: multisystemic therapy for conduct disorder · ApplicationA 14-year-old with conduct disorder has trouble in the family, at school and with a delinquent peer group. Which evidence-based intervention works across these systems?
- Child and adolescent psychiatry: childhood-onset conduct disorder · Multi-stepTwo boys are assessed. Boy A showed aggression and rule-breaking before age 10 with ADHD and harsh parenting. Boy B first broke rules at 15 with a delinquent peer group…
- Child and adolescent psychiatry: new-onset enuresis after dryness · Multi-stepA 7-year-old who was dry for over a year starts wetting nightly after the birth of a sibling, and also wets by day. What is the best next step?
- Child and adolescent psychiatry: desmopressin for short-term cover · Multi-stepA 10-year-old with primary nocturnal enuresis responds slowly to an alarm. He is going to a school camp in three days and wants dry nights for the trip. Which treatment…
- Child and adolescent psychiatry: treatment of encopresis · ApplicationA 6-year-old soils his underwear daily and has hard stools with a palpable faecal mass. What is the most appropriate management?
- Child and adolescent psychiatry: mandatory reporting of child sexual abuse in India · ApplicationA doctor in India suspects that a 10-year-old has been sexually abused. Under which Indian law is there a duty to report the suspicion to the authorities?
- Child and adolescent psychiatry: drug treatment of adolescent depression · ApplicationA 15-year-old with moderate to severe depression has not improved after several weeks of psychotherapy. Which antidepressant is the usual first choice?
- Child and adolescent psychiatry: management of school refusal · ApplicationA 9-year-old with anxiety refuses to go to school and has morning stomach aches with normal examination. What is the best approach?
- Child and adolescent psychiatry: disorganised attachment · Multi-stepIn a strange situation procedure, a 12-month-old approaches her mother on reunion with averted gaze, then freezes and falls to the floor. This contradictory behaviour s…
- Child and adolescent psychiatry: evaluating delayed speech · ApplicationA 2-year-old speaks only a few words and does not respond when called, though he plays well and has good eye contact. What should be done first?
- Child and adolescent psychiatry: developmental coordination disorder · ApplicationA 7-year-old with normal intelligence is notably clumsy, drops objects, cannot tie shoelaces or ride a bicycle, and has no neurological disease. Which diagnosis fits?
- Child and adolescent psychiatry: Landau-Kleffner syndrome · Multi-stepA 5-year-old with normal early speech gradually stops understanding spoken words over some months. Hearing is normal and sleep EEG shows epileptiform discharges. Which…
- Child and adolescent psychiatry: treatment of trauma in children · ApplicationA 9-year-old has nightmares, flashbacks and avoidance two months after a road accident. Which treatment is recommended first?
- Child and adolescent psychiatry: cri-du-chat syndrome · ApplicationA newborn has a high-pitched cat-like cry, microcephaly, hypertelorism and later severe intellectual disability. What is the chromosomal abnormality?
Anxiety and related disorders33
- Anxiety and related disorders: postpartum obsessions of harm · Multi-stepA mother of a six-week-old baby has frequent intrusive images of dropping the baby from the balcony. She is horrified, avoids bathing the baby, and checks on her repeat…
- Anxiety and related disorders: managing somatic symptom disorder · ApplicationA 45-year-old woman has had multiple unexplained symptoms for years, visits several doctors and calls the clinic whenever new symptoms appear. Investigations are repeat…
- Anxiety and related disorders: persistent somatoform pain disorder · ApplicationA 40-year-old man has had severe low back pain for 18 months, with no structural lesion on repeated MRI, and the pain is linked in time to marital conflict. Opioids hav…
- Anxiety and related disorders: suffocation false alarm theory · Multi-stepA patient with panic disorder has a panic attack when she breathes air with raised carbon dioxide in a laboratory, while controls feel only mild discomfort. Which theor…
- Anxiety and related disorders: thought-action fusion · ApplicationA man with OCD believes that merely thinking of his mother dying makes it more likely to happen, and that having the thought is as bad as wishing her dead. He performs…
- Anxiety and related disorders: negative cognitions in PTSD · ApplicationA soldier who survived an ambush in which his comrades died repeatedly says, 'It should have been me. I could have saved them.' Under which DSM-5 symptom cluster of PTS…
- Anxiety and related disorders: narcoanalytic interview · ApplicationA 24-year-old man is mute and cannot recall events after a road accident. Neurological examination and imaging are normal. Which procedure may help bring out the forgot…
- Anxiety and related disorders: mass psychogenic illness · ApplicationIn a rural school, a girl faints in assembly. Within an hour twelve more girls report dizziness, headache and breathlessness. Vital signs are normal, no toxin is found,…
- Anxiety and related disorders: sexual masochism · ApplicationA 28-year-old man has for over a year had intense recurrent sexual arousal from being bound, beaten and humiliated by his partner, and he finds it distressing. Which di…
- Anxiety and related disorders: intermittent explosive disorder · Multi-stepA 26-year-old man has sudden episodes of rage, smashing furniture and shouting at his family over minor annoyances. They last minutes, are followed by remorse, and he i…
- Anxiety and related disorders: kleptomania · ApplicationA 34-year-old well-off woman repeatedly steals inexpensive items she does not need. She feels rising tension before each act and relief afterwards, discards the items,…
- Anxiety and related disorders: pyromania · ApplicationA 22-year-old man has deliberately set fires on several occasions. He is fascinated by fire and the fire brigade, feels tension before and pleasure during and after the…
- Anxiety and related disorders: taijin kyofusho · ApplicationA 25-year-old man in Japan avoids trains and workplaces because he is convinced his body odour and facial expression embarrass and offend other people. He is not worrie…
- Anxiety and related disorders: SSRI initiation in panic · ApplicationA woman with panic disorder started sertraline at a high dose and within a week had increased anxiety, tremor and insomnia. She is willing to retry an SSRI. How should…
- Anxiety and related disorders: interoceptive exposure · Multi-stepIn CBT for panic disorder, a patient is asked in session to hyperventilate and spin on a swivel chair to provoke dizziness and a racing heart. She stays with the sensat…
- Anxiety and related disorders: pseudocyesis · ApplicationA 40-year-old woman desperate for a child has amenorrhoea, abdominal distension, breast enlargement and morning nausea, and firmly believes she is pregnant. Urine hCG i…
- Anxiety and related disorders: astasia-abasia · ApplicationAfter a family quarrel, a 28-year-old woman cannot stand or walk unaided. Neurological examination in bed shows normal power and sensation, and she moves her legs well…
- Anxiety and related disorders: undoing in OCD · ApplicationAfter having an unacceptable aggressive thought about his child, a man feels compelled to touch the door handle three times to 'cancel' the thought. Which defence mecha…
- Anxiety and related disorders: displacement in phobia · ApplicationIn Freud's case of 'Little Hans', a boy developed an intense fear of horses that he unconsciously linked to his fear of his father. Which defence mechanism, together wi…
- Anxiety and related disorders: neurocircuitry of OCD · ApplicationFunctional imaging in patients with obsessive-compulsive disorder, which often normalises with successful treatment, shows abnormal activity in which circuit?
- Anxiety and related disorders: SSRI-resistant OCD · Multi-stepA woman with OCD has had adequate trials of two SSRIs at maximum tolerated doses over 12 weeks each, along with good-quality exposure and response prevention, and still…
- Anxiety and related disorders: neurosurgery for OCD · ApplicationA man with severe, disabling OCD has failed every drug and behavioural treatment over many years. If a neurosurgical lesion procedure is considered, which is classicall…
- Anxiety and related disorders: nocturnal panic attack · Multi-stepA 30-year-old man repeatedly wakes from deep sleep in terror with palpitations, chest tightness and breathlessness. He is fully alert, recalls it clearly, and cannot re…
- Anxiety and related disorders: cognitive model of panic · ApplicationIn the cognitive model of panic disorder, a racing heart is read as a sign of an impending heart attack, which raises anxiety and the heart rate further. Which concept…
- Anxiety and related disorders: structural changes in PTSD · ApplicationWhich finding is most consistently reported in the brains of patients with chronic post-traumatic stress disorder?
- Anxiety and related disorders: prolonged exposure therapy · ApplicationA survivor of a violent assault repeatedly recounts the trauma in detail during sessions, records and listens to it between sessions, and gradually returns to avoided p…
- Anxiety and related disorders: organic cause of anxiety · ApplicationA 32-year-old woman has anxiety, palpitations, heat intolerance, weight loss despite good appetite and a fine tremor. Which first investigation is most useful before la…
- Anxiety and related disorders: caffeine-induced anxiety · ApplicationA medical student preparing for exams drinks eight cups of strong coffee and several energy drinks daily. She has restlessness, tremor, palpitations and insomnia, which…
- Anxiety and related disorders: late-onset anxiety · ApplicationA 68-year-old woman with no earlier psychiatric history develops new, marked anxiety over a few weeks. What is the most appropriate approach?
- Anxiety and related disorders: body dysmorphic disorder with absent insight · Multi-stepA 24-year-old man is completely convinced, with delusional intensity, that his nose is grotesque, although it is normal. He spends hours mirror-checking and camouflagin…
- Anxiety and related disorders: benzodiazepines in GAD · ApplicationA woman with generalised anxiety disorder starts an SSRI and is severely distressed in the first weeks. How should a benzodiazepine be used if added?
- Anxiety and related disorders: buspirone and benzodiazepine dependence · Multi-stepA woman dependent on lorazepam is advised to switch abruptly to buspirone for her anxiety. Within two days she has tremor, insomnia and anxiety. Why did buspirone fail…
- Anxiety and related disorders: SSRI jitteriness in panic disorder · Multi-stepA woman with panic disorder is started on sertraline 50 mg and returns after 4 days with greater anxiety, restlessness and more frequent attacks. She wants to stop. Wha…
Child psychiatry27
- Child psychiatry · ApplicationAn 8-year-old boy has been inattentive, constantly fidgeting and impulsive at school and at home for over a year, and his grades are falling. Which drug is considered f…
- Child psychiatry · ApplicationA 9-year-old boy has had repeated sudden eye blinking, shoulder jerks and throat clearing for 2 years, and recently began uttering obscene words involuntarily. Which dr…
- Child psychiatry: autism screening · ApplicationWhich screening tool is commonly used for autism at 16 to 30 months of age?
- Child psychiatry: autism treatment · ApplicationA 9-year-old autistic boy has severe irritability, aggression and self-injury despite behavioural interventions. Which drug classes have regulatory approval for this sy…
- Child psychiatry: ADHD criteria · ApplicationWhich statement about DSM-5 criteria for ADHD is correct?
- Child psychiatry: ADHD treatment · ApplicationWhich drug is a non-stimulant noradrenaline reuptake inhibitor used for ADHD, and has no abuse potential?
- Child psychiatry: conduct disorder · ApplicationA 13-year-old repeatedly bullies others, has set fires, run away from home, and been physically cruel to animals over the past year. The diagnosis is:
- Child psychiatry: Tourette disorder · ApplicationA 10-year-old boy has multiple motor tics and a vocal tic that began before 18 and have persisted for over a year. Which treatment is first-line for tics that cause sig…
- Child psychiatry: intellectual disability · ApplicationIn ICD-10, which IQ range corresponds to mild intellectual disability?
- Child psychiatry: selective mutism · ApplicationA 5-year-old speaks freely at home but does not speak at school for more than a month, although she understands everything. This is:
- Child psychiatry: encopresis · ApplicationWhich statement about encopresis is correct?
- Child psychiatry: Rett syndrome · ApplicationA girl develops normally until 12 months, then loses acquired hand skills, develops hand-wringing movements, deceleration of head growth and loss of speech. The gene in…
- Child psychiatry: childhood disintegrative disorder · Multi-stepA boy develops normally for 3 years, then over several months loses language, social skills, bowel control and play skills, with autistic features. This is best termed:
- Child psychiatry: reactive attachment disorder · Multi-stepA 4-year-old raised in a neglectful orphanage is emotionally withdrawn, rarely seeks comfort when distressed and is rarely responsive to comfort when offered. The diagn…
- Child psychiatry: atomoxetine · ApplicationA 10-year-old with ADHD and tics has worsening tics on methylphenidate. Which non-stimulant is a reasonable alternative?
- Child psychiatry: Tourette treatment · Multi-stepA 12-year-old with Tourette disorder has frequent disabling vocal and motor tics despite behavioural therapy. Which drug is commonly used?
- Child psychiatry: Vineland Social Maturity Scale · ApplicationThe Vineland Social Maturity Scale, adapted in India by Malin, yields which measure?
- Child psychiatry · ApplicationInattention and hyperactivity in multiple settings suggests what?
- Child psychiatry · ApplicationRestricted interests and social-communication differences suggest what?
- Child psychiatry · ApplicationWhat core domains are affected in attention-deficit/hyperactivity disorder?
- Child psychiatry · ApplicationWhat is an important approach in managing conduct problems in children?
- Child psychiatry · ApplicationWhat is a key feature of autism spectrum disorder?
- Child psychiatry · ApplicationWhat symptom domain is central in attention-deficit/hyperactivity disorder?
- Child psychiatry: autism spectrum disorder · ApplicationA child has persistent difficulty with reciprocal social interaction, limited shared imaginative play, insistence on routines, and highly restricted interests from earl…
- Child psychiatry: ADHD · ApplicationFor more than six months, a child has impairing inattention and hyperactive-impulsive behavior at both home and school, with onset before age 12. What is the most likel…
- Child psychiatry: ADHD · ApplicationFor attention-deficit/hyperactivity disorder, symptoms must be present in how many or more settings to support the diagnosis?
- Child psychiatry: autism · ApplicationWhich feature is required for autism spectrum disorder?
Eating and sleep disorders27
- Eating and sleep disorders: slow-wave sleep in ageing · ApplicationA 72-year-old man complains that his sleep is light and fragmented, with frequent awakenings, though he spends enough time in bed. Which change in sleep architecture wi…
- Eating and sleep disorders: nocturnal frontal lobe epilepsy · Multi-stepA 22-year-old man has up to twenty brief nocturnal episodes a week in which he suddenly sits up, thrashes his legs and shouts, always in the same stereotyped way, each…
- Eating and sleep disorders: muscle dysmorphia · ApplicationA 24-year-old bodybuilder with a very muscular physique believes he is small and frail, spends hours a day in the gym, avoids social events and uses anabolic steroids.…
- Eating and sleep disorders: residual sleepiness in sleep apnoea · ApplicationA 50-year-old obese man with obstructive sleep apnoea uses CPAP nightly with a good adherence record, yet he still has marked daytime sleepiness. Other causes are exclu…
- Eating and sleep disorders: rumination disorder · Multi-stepAn 8-month-old infant repeatedly brings up milk soon after feeds, chews and swallows it again, and is losing weight. There is no retching, distress or fever, and he see…
- Eating and sleep disorders: night eating syndrome · Multi-stepA 35-year-old woman has little appetite in the morning but eats more than a quarter of her daily intake after dinner and wakes most nights to eat. She is fully aware an…
- Eating and sleep disorders: REM rebound · Multi-stepA man who has drunk heavily every night stops abruptly. Over the next few nights he sleeps poorly and has intense, vivid, disturbing dreams, with a polysomnogram showin…
- Eating and sleep disorders: fatal familial insomnia · Multi-stepA 50-year-old man develops progressive, untreatable insomnia with sweating, tachycardia, hypertension and myoclonus, followed by dementia within a year. His father and…
- Eating and sleep disorders: shift work sleep disorder · ApplicationA nurse on rotating night shifts cannot sleep well during the day and feels very sleepy and makes errors at night. On her days off she sleeps normally. What is the most…
- Eating and sleep disorders: complication of forceful vomiting · Multi-stepA 22-year-old woman with recurrent binge eating and self-induced vomiting has one episode of violent retching and then develops severe retrosternal pain, fever and crep…
- Eating and sleep disorders: laboratory findings in bulimia nervosa · ApplicationA normal-weight woman who vomits after binges has painless bilateral swelling of the cheeks in front of the ears. Which laboratory change is most likely to accompany th…
- Eating and sleep disorders: amenorrhoea in anorexia nervosa · ApplicationA 16-year-old with a BMI of 14 has had no periods for 8 months. Which endocrine mechanism accounts for the amenorrhoea?
- Eating and sleep disorders: thyroid function in anorexia nervosa · ApplicationA severely underweight woman with anorexia nervosa complains of cold intolerance and constipation. Her thyroid function tests are being interpreted. Which pattern is ty…
- Eating and sleep disorders: bone loss in anorexia nervosa · Multi-stepA 17-year-old with anorexia nervosa has a bone density scan showing osteopenia. Her parents ask what will best protect her bones. Which measure is most effective?
- Eating and sleep disorders: female athlete triad · ApplicationA 19-year-old distance runner has a tibial stress fracture, irregular cycles and strict dietary restriction to stay lean. She is at risk of a recognised triad. Which th…
- Eating and sleep disorders: thiamine before refeeding · ApplicationA 24-year-old woman weighing 32 kg after months of near-total food refusal is to start nutritional rehabilitation. Which vitamin should be given before and during carbo…
- Eating and sleep disorders: psychological treatment of bulimia nervosa · ApplicationAn adult with bulimia nervosa binges and vomits several times a week. She is not medically unstable. Which psychological treatment has the strongest evidence as first-l…
- Eating and sleep disorders: first-line therapy for binge-eating disorder · ApplicationA 34-year-old obese woman has recurrent binges with distress but no vomiting or laxative use. She prefers a non-drug approach. Which therapy is recommended first?
- Eating and sleep disorders: anorexia binge-purge subtype versus bulimia · Multi-stepA 20-year-old woman has a BMI of 15.5 and intense fear of weight gain. She has recurrent binge episodes followed by vomiting and laxative use. Which diagnosis is correct?
- Eating and sleep disorders: multiple sleep latency test in narcolepsy · Multi-stepA 22-year-old with excessive daytime sleepiness undergoes overnight polysomnography followed by a daytime nap study with five nap opportunities. Which result supports n…
- Eating and sleep disorders: drug for cataplexy · Multi-stepA man with narcolepsy is alert on modafinil but still has several episodes a week of knee buckling when he laughs. Which drug is most appropriate to reduce the cataplexy?
- Eating and sleep disorders: treatment of delayed sleep phase · Multi-stepA 17-year-old falls asleep at 3 am and wakes at 11 am without difficulty on holidays, but cannot attend morning school. Which timed treatment shifts her rhythm earlier?
- Eating and sleep disorders: effect of benzodiazepines on sleep stages · Multi-stepA polysomnogram is recorded in a patient taking nightly diazepam. Which change in sleep architecture is expected compared with a drug-free night?
- Eating and sleep disorders: isolated sleep paralysis · ApplicationA healthy 21-year-old student wakes in the early morning fully aware but unable to move or speak for about a minute. There is no daytime sleepiness or cataplexy. What b…
- Eating and sleep disorders: management of childhood sleepwalking · ApplicationA 7-year-old walks around the house about an hour after falling asleep once or twice a month and does not recall it. Examination is normal. What is the most appropriate…
- Eating and sleep disorders: idiopathic hypersomnia · Multi-stepA 24-year-old sleeps 11 hours nightly yet wakes unrefreshed with marked grogginess. Long naps do not refresh him. He has no cataplexy, and a nap study shows short laten…
- Eating and sleep disorders: augmentation in restless legs syndrome · Multi-stepA woman with restless legs syndrome has taken pramipexole for two years. Symptoms now begin in mid-afternoon, are more intense and have spread to the arms. What is this…
Anxiety disorders26
- Anxiety disorders · ApplicationWhat is the first-line treatment for obsessive-compulsive disorder?
- Anxiety disorders · ApplicationA 28-year-old woman has repeated episodes of sudden palpitations, sweating, trembling and a feeling of impending doom that peak within 10 minutes. Between episodes she…
- Anxiety disorders · ApplicationA musician has marked tremor, palpitations and sweating only before public performances, with no symptoms otherwise. Which drug is most suitable for situational use?
- Anxiety disorders: panic disorder · ApplicationA 30-year-old has recurrent sudden episodes of palpitations, sweating, fear of dying and breathlessness, peaking within 10 minutes. Between attacks, he fears another at…
- Anxiety disorders: social anxiety · ApplicationA musician is terrified of public performance, with tachycardia and tremor, but is comfortable in other social settings. For occasional use before performances, the mos…
- Anxiety disorders: specific phobia · ApplicationThe most effective treatment for a specific phobia of lifts is:
- Anxiety disorders: hyperventilation · ApplicationA young woman in a panic attack presents with tingling around the mouth, carpopedal spasm and light-headedness with rapid breathing. The most appropriate immediate step…
- Anxiety disorders: lactate and panic · ApplicationIntravenous infusion of sodium lactate or inhalation of carbon dioxide can provoke panic attacks in susceptible people. Which brain region has been implicated?
- Anxiety disorders: GAD pharmacotherapy · ApplicationFor long-term pharmacological treatment of generalised anxiety disorder, which is first-line?
- Anxiety disorders: blood-injury phobia · Multi-stepA man faints when he sees blood during venepuncture. His pulse falls and blood pressure drops, unlike other phobias. Which technique is specifically useful?
- Anxiety disorders: organic mimics · ApplicationA 35-year-old woman has episodic palpitations, headache, sweating and severe hypertension during attacks. Which investigation helps exclude an organic mimic of panic?
- Anxiety disorders · ApplicationWhat is a core feature of generalized anxiety disorder?
- Anxiety disorders · ApplicationA panic attack is best described as what?
- Anxiety disorders · ApplicationWhat is agoraphobia commonly characterized by?
- Anxiety disorders · ApplicationWhat therapy has strong evidence for specific phobias?
- Anxiety disorders · ApplicationWhat is social anxiety disorder primarily characterized by?
- Anxiety disorders · ApplicationWhat symptom often occurs during a panic attack?
- Anxiety disorders · ApplicationWhat is the core feature of generalized anxiety disorder?
- Anxiety disorders · ApplicationWhat treatment is core to exposure therapy for phobia?
- Anxiety disorders · ApplicationWhat is a panic attack?
- Anxiety disorders · ApplicationWhat is central to obsessive-compulsive disorder?
- Anxiety disorders: generalized anxiety disorder · ApplicationFor eight months, a patient worries excessively about finances, family health, and work on most days. The worry is hard to control and is accompanied by restlessness, m…
- Anxiety disorders: panic disorder · ApplicationRecurrent unexpected panic attacks followed by persistent worry about further attacks most strongly indicates what disorder?
- Anxiety disorders: PTSD · ApplicationNightmares, intrusive memories, avoidance and hypervigilance lasting more than a month after a violent assault are most consistent with what diagnosis?
- Anxiety disorders · ApplicationWhat is the defining feature of a panic attack?
- Anxiety disorders · ApplicationWhat is agoraphobia primarily a fear of?
Antipsychotics25
- Antipsychotics: hyperprolactinaemia · ApplicationA young woman on risperidone develops galactorrhoea and amenorrhoea. The mechanism is blockade of dopamine D2 receptors in which pathway?
- Antipsychotics: treatment-resistant schizophrenia · Multi-stepA patient with schizophrenia continues to have disabling hallucinations after adequate trials of two different antipsychotics, each for at least 6 weeks and with confir…
- Antipsychotics: clozapine myocarditis · Multi-stepA patient who started clozapine two weeks ago develops fever, tachycardia, chest discomfort and raised troponin and CRP. What is the most likely cause?
- Antipsychotics: tardive dyskinesia management · Multi-stepA man on haloperidol for 8 years develops lip smacking, tongue protrusion and choreiform limb movements. The drug that is specifically approved for this condition is:
- Antipsychotics: neuroleptic malignant syndrome · ApplicationTwo days after haloperidol was increased, a patient has temperature 40 C, lead-pipe rigidity, confusion, autonomic instability and CK of 8000 U/L. First steps include s…
- Antipsychotics: aripiprazole · ApplicationWhich antipsychotic acts as a partial agonist at D2 receptors and is associated with a low risk of hyperprolactinaemia?
- Antipsychotics: risperidone · ApplicationAmong second-generation antipsychotics, which one is most strongly associated with raised serum prolactin at usual doses?
- Antipsychotics: thioridazine · Multi-stepA phenothiazine given in high doses is known to cause pigmentary retinopathy and marked QT prolongation. It is:
- Antipsychotics: akathisia · ApplicationThree days after starting haloperidol, a patient is unable to sit still, paces the ward and says he feels a compelling inner restlessness. The drug most useful for trea…
- Antipsychotics: ziprasidone · Multi-stepTo ensure adequate absorption, the oral antipsychotic ziprasidone should be taken:
- Antipsychotics: chlorpromazine adverse effects · ApplicationA patient on long-term chlorpromazine develops a blue-grey discolouration of sun-exposed skin and corneal opacities. Which is the likely cause?
- Antipsychotics: quetiapine · ApplicationWhich atypical antipsychotic has approval for both acute mania and bipolar depression, and carries low EPS risk but marked sedation and weight gain?
- Antipsychotics: lurasidone · Multi-stepWhich statement about lurasidone is correct?
- Antipsychotics: amisulpride · Multi-stepA patient with predominantly negative symptoms of schizophrenia is given low-dose amisulpride. Its pharmacological property is:
- Antipsychotics: pimavanserin · Multi-stepParkinson disease psychosis (hallucinations and delusions) can be treated with a drug that is a selective 5-HT2A inverse agonist without D2 blockade. It is:
- Antipsychotics: dementia-related psychosis · ApplicationWhat is the key safety warning on antipsychotics when used in elderly patients with dementia-related psychosis?
- Antipsychotics: clozapine side effects · ApplicationA patient on clozapine has troublesome drooling at night. Which statement is correct?
- Antipsychotics: clozapine receptor profile · ApplicationAtypical antipsychotics differ from typical agents by having
- Antipsychotics: QT prolongation · ApplicationBefore starting thioridazine or a high-dose of a QT-prolonging antipsychotic, which baseline test is advisable?
- Antipsychotics: olanzapine-fluoxetine combination · Multi-stepA fixed combination approved for bipolar I depression and treatment-resistant depression contains
- Antipsychotics: pimozide · ApplicationPimozide is used in practice for
- Antipsychotics: Pisa syndrome · Multi-stepA patient on risperidone develops a sustained lateral flexion of the trunk to one side while sitting and standing. This is
- Antipsychotics: cariprazine · Multi-stepCariprazine and brexpiprazole are described as
- Antipsychotics · ApplicationRestlessness after antipsychotic is called what?
- Antipsychotics · ApplicationOrofacial movements after chronic antipsychotic use suggest what?
Organic psychiatry25
- Organic psychiatry · ApplicationAn elderly patient on a surgical ward develops acute confusion that fluctuates through the day, with visual hallucinations and disturbed sleep. What is the most likely…
- Organic psychiatry · ApplicationWhich feature favours delirium rather than dementia?
- Organic psychiatry: autoimmune encephalitis · Multi-stepA 23-year-old woman develops, over two weeks, agitation, paranoid delusions and insomnia after a flu-like illness, followed by seizures, orofacial dyskinesias and auton…
- Organic psychiatry: delirium EEG · Multi-stepThe characteristic EEG finding in delirium (except delirium tremens) is:
- Organic psychiatry: frontotemporal dementia · ApplicationA 58-year-old man becomes disinhibited, makes inappropriate jokes, eats compulsively and loses empathy, yet his memory and visuospatial skills are initially preserved.…
- Organic psychiatry: normal pressure hydrocephalus · ApplicationAn elderly man has a magnetic gait, urinary incontinence and progressive cognitive decline. Imaging shows ventriculomegaly with normal CSF pressure. Treatment is:
- Organic psychiatry: Creutzfeldt-Jakob disease · ApplicationA 62-year-old develops rapidly progressive dementia, myoclonic jerks and ataxia over 4 months. EEG shows periodic sharp wave complexes. The diagnosis is:
- Organic psychiatry: pseudodementia · ApplicationAn elderly man with low mood says 'I don't know' to most questions, makes little effort on testing, and has rapid onset of cognitive complaints. The most likely diagnos…
- Organic psychiatry: Ganser syndrome · Multi-stepA prisoner awaiting trial gives approximate answers such as 'a horse has five legs' to simple questions, showing clouding of consciousness and hallucinations. This is:
- Organic psychiatry: temporal lobe epilepsy · Multi-stepA patient with long-standing temporal lobe epilepsy becomes intensely religious, writes extensively (hypergraphia) and has reduced libido, with viscosity of interaction…
- Organic psychiatry: Kluver-Bucy syndrome · ApplicationAfter bilateral temporal lobectomy a patient puts every object in his mouth, shows marked hypersexuality, is placid and is unable to recognise objects visually. This is:
- Organic psychiatry: hypoactive delirium · ApplicationA post-operative elderly patient is lethargic, drowsy and slow to respond, and the team considers him depressed. Why is this presentation important?
- Organic psychiatry: Confusion Assessment Method · ApplicationThe Confusion Assessment Method diagnoses delirium when acute onset with fluctuating course and inattention are present together with
- Organic psychiatry: delirium drug treatment · ApplicationA 78-year-old with hyperactive delirium after pneumonia is distressed and trying to pull out his drip. After non-drug measures fail, which drug is the usual choice?
- Organic psychiatry: delirium in alcohol withdrawal · Multi-stepA hospitalised man with delirium tremens has coarse tremor, tachycardia and visual hallucinations on day three of admission. The drug of choice is
- Organic psychiatry: Lewy body versus Parkinson dementia · Multi-stepIn the one-year rule for distinguishing dementia with Lewy bodies from Parkinson disease dementia, a diagnosis of dementia with Lewy bodies is made when
- Organic psychiatry: variant CJD · Multi-stepA 26-year-old develops depression, painful sensory symptoms, ataxia and then dementia with myoclonus over a year. MRI shows a pulvinar (hockey-stick) sign. The likely d…
- Organic psychiatry: reversible dementia · ApplicationA 65-year-old has slowly progressive forgetfulness, macrocytosis and paraesthesia in the feet. Which investigation is most important?
- Organic psychiatry: general paresis · ApplicationA 45-year-old man has grandiose delusions, euphoria, tremor of the tongue and facial muscles, dysarthria and small irregular pupils that accommodate but do not react to…
- Organic psychiatry: frontal lobe syndrome · ApplicationAfter a road accident, a previously polite man jokes inappropriately, shows poor judgment and apathy, and persists in a wrong response in a card-sorting test. Which are…
- Organic psychiatry: Gerstmann syndrome · ApplicationA patient after a stroke cannot write, cannot calculate, cannot name his fingers and confuses left with right. The lesion is in the
- Organic psychiatry: right parietal lesion · ApplicationA man after a right middle cerebral artery stroke ignores the left side of his body, shaves only the right half of his face and denies that his left arm is paralysed. T…
- Organic psychiatry: HIV-associated neurocognitive disorder · Multi-stepA 35-year-old man with advanced HIV develops psychomotor slowing, apathy and impaired concentration with MRI showing diffuse atrophy. The appropriate disease-modifying…
- Organic psychiatry: hepatic encephalopathy · ApplicationA cirrhotic patient is drowsy and disoriented with a flapping tremor of outstretched hands. Which drug is used to reduce the precipitating gut load of ammonia?
- Organic psychiatry: post-concussional syndrome · ApplicationWeeks after a mild head injury with brief loss of consciousness, a man complains of headache, dizziness, irritability, poor concentration and fatigue, with a normal CT.…
Eating disorders21
- Eating disorders · ApplicationA 17-year-old girl has a BMI of 15, amenorrhoea, lanugo hair, bradycardia and an intense fear of gaining weight. What is the diagnosis?
- Eating disorders: anorexia nervosa · ApplicationA 16-year-old girl with a BMI of 15, amenorrhoea and intense fear of weight gain, who sees herself as fat, is admitted. Which complication must be watched for during re…
- Eating disorders: bulimia nervosa · ApplicationA young woman of normal weight has recurrent episodes of binge eating followed by self-induced vomiting. Examination shows calluses on the knuckles and parotid enlargem…
- Eating disorders: bulimia nervosa treatment · ApplicationThe antidepressant with evidence for use in bulimia nervosa at relatively high dose (60 mg) is:
- Eating disorders: binge eating disorder · Multi-stepWhich drug is approved for moderate to severe binge eating disorder in adults?
- Eating disorders: family-based therapy · ApplicationA 14-year-old girl with anorexia nervosa of recent onset is medically stable. Which treatment has the best evidence?
- Eating disorders: Russell sign · ApplicationA 22-year-old woman has parotid swelling, dental enamel erosion and calluses on the dorsum of the hand. She is of normal weight. The calluses are called
- Eating disorders: ARFID · ApplicationA 9-year-old restricts food to a few textures, has weight loss and nutritional deficiency and has no fear of weight gain or body image disturbance. The diagnosis is
- Eating disorders: metabolic complications of purging · Multi-stepA woman with bulimia nervosa who vomits daily presents with weakness and palpitations. Which acid-base and electrolyte abnormality is expected?
- Eating disorders · ApplicationBinge eating with compensatory vomiting suggests what?
- Eating disorders · ApplicationWhat is a key feature of anorexia nervosa?
- Eating disorders · ApplicationWhat behavior is characteristic of bulimia nervosa?
- Eating disorders · ApplicationWhat medical complication requires attention in anorexia nervosa?
- Eating disorders · ApplicationWhat behavior is a compensatory method in bulimia nervosa?
- Eating disorders · ApplicationWhat is body-image disturbance?
- Eating disorders · ApplicationWhat behavior is typical of bulimia nervosa?
- Eating disorders · ApplicationWhich feature most suggests anorexia nervosa?
- Eating disorders · ApplicationWhat behavior is typical of bulimia nervosa?
- Eating disorders: bulimia nervosa · ApplicationA patient of average body weight has recurrent binge-eating episodes followed by self-induced vomiting at least weekly for several months. Self-evaluation is excessivel…
- Eating disorders: anorexia nervosa · ApplicationWhich laboratory abnormality is particularly dangerous in a severely malnourished patient with anorexia nervosa who begins nutritional rehabilitation?
- Eating disorders · ApplicationWhat feature differentiates anorexia nervosa from bulimia nervosa?
Schizophrenia19
- Schizophrenia: DSM-5 duration · ApplicationAccording to DSM-5, the overall duration of illness required for the diagnosis of schizophrenia, including prodromal and residual phases, is at least:
- Schizophrenia: prognostic factors · Multi-stepWhich of the following is a feature of good prognosis in schizophrenia?
- Schizophrenia: dopamine pathways · ApplicationIn the dopamine hypothesis of schizophrenia, excess dopaminergic activity in which pathway is thought to cause positive symptoms?
- Schizophrenia: expressed emotion · ApplicationA patient with schizophrenia returns to a household where relatives are critical, hostile and emotionally over-involved. What is the expected effect on his illness?
- Schizophrenia: genetics · ApplicationApproximately what is the concordance rate for schizophrenia in monozygotic twins?
- Schizophrenia: neuroimaging · ApplicationWhich finding is most consistently reported in the brain imaging of patients with chronic schizophrenia?
- Schizophrenia: hebephrenic subtype · ApplicationIn ICD-10, an 18-year-old develops silly giggling, mannerisms, incoherent speech and shallow inappropriate affect over a year, with no organised delusions. Which subtyp…
- Schizophrenia: simple schizophrenia · ApplicationA 20-year-old gradually loses interest in studies, becomes socially withdrawn and neglects hygiene over two years, with no hallucinations or delusions at any time. Whic…
- Schizophrenia: post-schizophrenic depression · Multi-stepUnder ICD-10, a patient with schizophrenia in the past 12 months, now with few residual psychotic symptoms, develops a prolonged depressive episode. Which diagnosis is…
- Schizophrenia: residual type · ApplicationIn ICD-10, a man with a 15-year history of schizophrenia now shows blunted affect, poverty of speech and social withdrawal, with no hallucinations or delusions for the…
- Schizophrenia: glutamate hypothesis · ApplicationPhencyclidine and ketamine produce positive, negative and cognitive symptoms that resemble schizophrenia. This supports which hypothesis?
- Schizophrenia: epidemiological risk factors · ApplicationWhich of the following is an established environmental risk factor for schizophrenia?
- Schizophrenia: CATIE trial · Multi-stepIn the CATIE trial of chronic schizophrenia, which finding was reported?
- Schizophrenia: family psychoeducation · ApplicationA family of a patient with schizophrenia shows high expressed emotion with frequent criticism and over-involvement. Which intervention reduces relapse?
- Schizophrenia: cognitive remediation · ApplicationWhich psychosocial intervention is directed at improving attention, memory and executive function in schizophrenia?
- Schizophrenia · ApplicationWhich is a positive symptom of schizophrenia?
- Schizophrenia · ApplicationWhich is a negative symptom of schizophrenia?
- Schizophrenia · ApplicationWhat is disorganized speech in psychosis?
- Schizophrenia · ApplicationWhich feature is a negative symptom of schizophrenia?
Antidepressants16
- Antidepressants: discontinuation syndrome · ApplicationA patient abruptly stops paroxetine and develops dizziness, flu-like symptoms, irritability, electric shock sensations and nausea. The most appropriate step is:
- Antidepressants: serotonin syndrome · Multi-stepA patient on sertraline is given tramadol for pain and develops agitation, diaphoresis, hyperreflexia, inducible ankle clonus and temperature of 39 C. The drug that can…
- Antidepressants: MAOI interaction · ApplicationA patient on phenelzine eats mature cheese and develops a severe throbbing headache with blood pressure of 220/120 mm Hg. The cause is:
- Antidepressants: tricyclic overdose · Multi-stepA patient who took many amitriptyline tablets has a wide QRS complex on ECG and ventricular arrhythmias. Which treatment is indicated?
- Antidepressants: bupropion · ApplicationWhich statement about bupropion is correct?
- Antidepressants: mirtazapine · ApplicationA thin elderly depressed patient with insomnia and poor appetite is prescribed an antidepressant that blocks alpha-2 receptors, 5-HT2 and 5-HT3 receptors and H1 recepto…
- Antidepressants: venlafaxine · ApplicationA patient on a high dose of venlafaxine develops sustained hypertension. This is explained by:
- Antidepressants: trazodone · ApplicationAn antidepressant with strong sedation used for insomnia, which can cause a prolonged painful erection in men, is:
- Antidepressants: sexual dysfunction · ApplicationA man on sertraline develops delayed ejaculation and reduced libido. Which switching option is least likely to cause sexual dysfunction?
- Antidepressants: hyponatraemia · ApplicationA 75-year-old woman on an SSRI becomes confused, with serum sodium of 120 mmol/L and concentrated urine. The probable mechanism is:
- Antidepressants: bleeding risk · Multi-stepSSRIs increase the risk of gastrointestinal bleeding especially when combined with:
- Antidepressants: agomelatine · Multi-stepWhich antidepressant is an agonist at melatonin MT1 and MT2 receptors and an antagonist at 5-HT2C, and requires monitoring of liver function?
- Antidepressants: paroxetine in pregnancy · Multi-stepA pregnant woman with depression asks which SSRI to avoid in the first trimester because of cardiac malformation concerns. The usual answer is
- Antidepressants: moclobemide · ApplicationA depressed patient needs an MAOI but wants to avoid dietary restriction. Which drug is a reversible inhibitor of MAO-A with minimal tyramine interaction?
- Antidepressants: duloxetine · ApplicationA diabetic patient with painful neuropathy and major depression needs one drug for both conditions. Which is suitable?
- Antidepressants: vortioxetine · Multi-stepWhich antidepressant acts as a serotonin transporter inhibitor and a modulator of several 5-HT receptors, and may improve cognitive symptoms in depression?
Personality disorders16
- Personality disorders · ApplicationA 24-year-old woman has unstable relationships, impulsive spending, recurrent self-cutting, chronic emptiness and intense fear of abandonment. Which psychotherapy has t…
- Personality disorders: antisocial · ApplicationA 26-year-old man has a long record of lying, fights, unpaid debts and reckless driving. He shows no remorse, and as a teenager he truanted, set fires and was cruel to…
- Personality disorders: schizotypal · ApplicationA 30-year-old lives alone, believes he can read others' thoughts, dresses oddly, talks in vague, circumstantial speech and has no close friends. There is no frank psych…
- Personality disorders: obsessive-compulsive personality · ApplicationA man is preoccupied with rules, lists and perfectionism, which interferes with completing tasks. He is stubborn and hoards money, but sees these traits as reasonable a…
- Personality disorders: avoidant · Multi-stepA man desires close relationships but avoids social situations because of intense fear of criticism, feelings of inadequacy and hypersensitivity to negative evaluation.…
- Personality disorders: borderline features · ApplicationA 22-year-old woman has intense unstable relationships alternating between idealisation and devaluation, recurrent self-cutting, chronic emptiness and fear of abandonme…
- Personality disorders: dependent · ApplicationA woman cannot make everyday decisions without excessive advice, goes to great lengths to obtain support and feels helpless when alone. This is
- Personality disorders: dissocial in ICD-10 · ApplicationIn ICD-10 the equivalent of antisocial personality disorder is called
- Personality disorders: pharmacotherapy in borderline · Multi-stepA woman with borderline personality disorder is in crisis with impulsive overdoses. What is the best approach to medication?
- Personality disorders · ApplicationWhat is a defining aspect of personality disorder?
- Personality disorders · ApplicationWhat is a principle of managing personality disorder?
- Personality disorders · ApplicationWhat describes personality-disorder traits?
- Personality disorders · ApplicationWhich feature is associated with borderline personality disorder?
- Personality disorders: borderline personality disorder · ApplicationA patient has unstable intense relationships, frantic efforts to avoid abandonment, recurrent self-harm, chronic emptiness, and marked affective instability. Which pers…
- Personality disorders: borderline · ApplicationWhich pattern best supports borderline personality disorder?
- Personality disorders · ApplicationWhich pattern is typical of borderline personality disorder?
Psychopathology15
- Psychopathology · ApplicationA man with elevated mood speaks rapidly and jumps from topic to topic. Each shift is triggered by rhymes or by objects in the room, and the links remain understandable.…
- Psychopathology: illusion · ApplicationIn dim light a boy walking home mistakes a coiled rope on the road for a snake and screams. When a torch is shone he realises his mistake. This is an example of:
- Psychopathology: functional hallucination · Multi-stepA patient hears abusive voices only while a tap is running and they stop when the tap is closed. The voices are heard along with the real sound. This is called:
- Psychopathology: hypnagogic hallucination · ApplicationA 22-year-old student sees brief vivid images and hears his name just as he is drifting off to sleep. He is otherwise well. This phenomenon is:
- Psychopathology: passivity phenomena · ApplicationA patient states that thoughts which are not his own are being placed in his head by a radio transmitter. This symptom is:
- Psychopathology: pseudohallucination · ApplicationA grieving widow vividly sees her late husband's face in her mind and hears his voice inside her head. She knows it is her imagination. This phenomenon is:
- Psychopathology: primary delusion · Multi-stepA patient says that suddenly one morning he just 'knew' that he was the chosen saviour of the world. The belief appeared fully formed with no preceding thought process.…
- Psychopathology: delusional perception · Multi-stepA man sees a red traffic light and at once becomes convinced that this means his family is to be murdered. The percept was normal, but a private delusional meaning was…
- Psychopathology: clang association · ApplicationAn elated patient says, 'I am a king, ring, sing, bring the thing.' The words are chosen for their sound rather than meaning. Which disturbance is this?
- Psychopathology: mannerism versus stereotypy · ApplicationA patient repeatedly rocks his trunk back and forth for hours with no apparent purpose. In contrast, another patient walks with an odd, exaggerated gait but is clearly…
- Psychopathology: confabulation · ApplicationA man with chronic alcohol use cannot recall what he did yesterday but fluently narrates a detailed, incorrect account of his morning to fill the gap, believing it. Thi…
- Psychopathology: delusional memory · Multi-stepA patient states, 'Last Tuesday I suddenly remembered that I had been the crown prince since birth and my parents hid this.' There is no amnesia. This is best classifie…
- Psychopathology: delusional infestation · ApplicationA 62-year-old woman is convinced that tiny insects are crawling under her skin. She brings matchboxes containing skin fragments as proof, although dermatology finds not…
- Psychopathology: mood-congruent delusions · ApplicationIn a patient with severe depression, which delusion is mood-congruent?
- Psychopathology: alexithymia · ApplicationA patient with multiple unexplained somatic complaints cannot identify or describe his feelings and speaks only of physical sensations and external events. This difficu…
Psychosis15
- Psychosis · ApplicationA belief that others are plotting harm is what?
- Psychosis · ApplicationAuditory voice without stimulus is what?
- Psychosis · ApplicationA fixed false belief held despite contrary evidence is called what?
- Psychosis · ApplicationPerceiving a voice without an external stimulus is what?
- Psychosis · ApplicationA person mistakes a coat hanging in dim light for a threatening figure; what is this phenomenon called?
- Psychosis · ApplicationWhat thought process is suggested when ideas shift rapidly with superficial links in mania?
- Psychosis · ApplicationWhat is a persecutory delusion?
- Psychosis · ApplicationWhat is thought insertion?
- Psychosis · ApplicationWhat is a hallucination?
- Psychosis · ApplicationA person mistakes a coat hanging in dim light for an intruder; which perceptual phenomenon is this?
- Psychosis: schizophrenia · ApplicationWhich symptom is classified as a negative symptom of schizophrenia?
- Psychosis: antipsychotic adverse effects · Multi-stepA patient taking haloperidol develops fever, severe rigidity, autonomic instability and raised creatine kinase. What is the diagnosis?
- Psychosis: clozapine · ApplicationWhy are regular full blood counts mandatory for a patient receiving clozapine?
- Psychosis · ApplicationWhat is a first-rank symptom historically associated with schizophrenia?
- Psychosis · ApplicationWhich feature favors delirium over primary psychosis?
Sleep disorders15
- Sleep disorders · ApplicationA 19-year-old student repeatedly falls asleep during lectures. When he laughs, his knees buckle without loss of consciousness, and he has vivid hallucinations as he fal…
- Sleep disorders: parasomnias · ApplicationA 5-year-old child sits up screaming, with a racing heart and dilated pupils, about an hour after falling asleep. He cannot be consoled, and does not remember the episo…
- Sleep disorders: narcolepsy · ApplicationA 20-year-old has irresistible daytime sleep attacks, sudden loss of muscle tone on laughing, sleep paralysis and hypnagogic hallucinations. The underlying defect is lo…
- Sleep disorders: REM sleep behaviour disorder · Multi-stepA 65-year-old man punches and shouts in his sleep, enacting his dreams and injuring his wife. Polysomnography shows REM sleep without atonia. This disorder predicts lat…
- Sleep disorders: restless legs syndrome · ApplicationA woman has an irresistible urge to move her legs, worse at night and relieved by movement. Serum ferritin is low. The first step in management is:
- Sleep disorders: REM sleep and depression · ApplicationWhich sleep architecture change is characteristic of major depression?
- Sleep disorders: CBT for insomnia · ApplicationA 40-year-old with chronic insomnia asks for a long-term, non-drug treatment. Which component is part of CBT for insomnia?
- Sleep disorders: Kleine-Levin syndrome · Multi-stepA 16-year-old boy has recurrent episodes lasting days in which he sleeps 18 hours daily, eats voraciously and is irritable, apathetic and sexually disinhibited, and is…
- Sleep disorders: nightmares versus night terrors · ApplicationA child wakes frightened from a vivid dream about being chased, is alert, comforts easily and describes the dream in detail. This is
- Sleep disorders: delayed sleep phase · ApplicationA 17-year-old cannot fall asleep until 3 am and cannot wake for school, but sleeps normally and well if allowed to follow his own schedule. The disorder is
- Sleep disorders · ApplicationWhich sleep complaint involves persistent trouble falling asleep, staying asleep, or both?
- Sleep disorders · ApplicationWhat is a common behavioral treatment component for chronic insomnia?
- Sleep disorders · ApplicationWhat syndrome causes excessive daytime sleepiness with cataplexy?
- Sleep disorders · ApplicationWhat is a defining symptom of narcolepsy?
- Sleep disorders: narcolepsy · ApplicationSudden loss of muscle tone triggered by laughter in a sleepy young adult is called what?
Mental state examination13
- Mental state examination · ApplicationWhat term describes a patient's reported internal emotional state?
- Mental state examination · ApplicationWhat term describes the observable expression of emotion?
- Mental state examination · ApplicationWhat term describes the organization and flow of a person's thoughts?
- Mental state examination · ApplicationWhat term describes awareness that one has an illness and may need treatment?
- Mental state examination · ApplicationWhat cognitive domain assesses awareness of time, place, and person?
- Mental state examination · ApplicationWhat term describes a patient's beliefs about external reality?
- Mental state examination · ApplicationWhat cognitive ability allows a patient to sustain focus on a task?
- Mental state examination · ApplicationWhat bedside task assesses short-term memory?
- Mental state examination · ApplicationWhat term describes a patient's observable emotional expression?
- Mental state examination · ApplicationWhat term describes a patient's sustained subjective emotional state?
- Mental state examination · ApplicationWhat is an illusion in psychopathology?
- Mental state examination · ApplicationWhich mental-state-examination domain assesses whether thoughts are logically connected?
- Mental state examination · ApplicationWhat is an illusion in psychopathology?
Dementia11
- Dementia · ApplicationVisual hallucinations and parkinsonism suggest what dementia?
- Dementia · ApplicationStepwise decline after strokes suggests what?
- Dementia · ApplicationEarly behavioral disinhibition suggests what?
- Dementia · ApplicationAcute fluctuating inattention suggests what?
- Dementia · ApplicationWhat is typical of dementia?
- Dementia · ApplicationWhat is an early feature of many dementias?
- Dementia · ApplicationWhat distinction is important between depression and dementia?
- Dementia · ApplicationWhat clinical feature favors Lewy body dementia?
- Dementia · ApplicationWhat support is important for caregivers of people with dementia?
- Dementia · ApplicationWhat cognitive domain is often affected early in Alzheimer disease?
- Dementia: Lewy body disease · ApplicationFluctuating cognition, recurrent visual hallucinations and parkinsonism suggest which neurodegenerative disorder?
Mood stabilisers11
- Mood stabilisers: lithium levels · ApplicationThe generally accepted therapeutic serum lithium range is:
- Mood stabilisers: lithium toxicity · Multi-stepA patient on lithium develops vomiting, diarrhoea, coarse tremor, ataxia and slurred speech. Serum lithium is 2.3 mmol/L. The treatment of choice in severe toxicity is:
- Mood stabilisers: lithium interactions · Multi-stepA patient stable on lithium is started on hydrochlorothiazide for hypertension, and develops tremor and nausea. Why?
- Mood stabilisers: lithium teratogenicity · ApplicationFirst-trimester exposure to lithium carries a small increased risk of which fetal malformation?
- Mood stabilisers: lithium long-term effects · ApplicationA patient on lithium for 10 years complains of polyuria and polydipsia, with dilute urine not responding to vasopressin. The likely diagnosis is:
- Mood stabilisers: valproate adverse effects · ApplicationA young woman with bipolar disorder on sodium valproate develops weight gain, irregular menses and hirsutism. Which condition does valproate predispose to?
- Mood stabilisers: carbamazepine · ApplicationBefore starting carbamazepine in a patient of South Asian or Han Chinese ancestry, which test is recommended to reduce the risk of Stevens-Johnson syndrome?
- Mood stabilisers: lamotrigine · Multi-stepLamotrigine for bipolar depression is started at a low dose and titrated slowly mainly to reduce the risk of:
- Mood stabilisers: carbamazepine hyponatraemia · ApplicationA bipolar patient on carbamazepine becomes lethargic with confusion, and serum sodium is 119 mEq per litre. The mechanism is
- Mood stabilisers: valproate in women of childbearing age · ApplicationValproate use in the first trimester is most associated with
- Mood stabilisers: lithium · ApplicationWhich laboratory abnormality is typical of lithium-induced nephrogenic diabetes insipidus?
Mental Healthcare Act 201710
- Mental Healthcare Act 2017: advance directive · ApplicationUnder the Mental Healthcare Act 2017, a person can state in advance how he wishes to be treated, or not treated, for a mental illness. This provision is called:
- Mental Healthcare Act 2017: nominated representative · ApplicationWho may appoint a nominated representative under the Mental Healthcare Act 2017?
- Mental Healthcare Act 2017: suicide · ApplicationAccording to the Mental Healthcare Act 2017, a person who attempts suicide is:
- Mental Healthcare Act 2017: insurance · Multi-stepWhat does the Mental Healthcare Act 2017 require of insurers regarding mental illness?
- Mental Healthcare Act 2017: ECT · ApplicationWhich statement about ECT under the Mental Healthcare Act 2017 is correct?
- Mental Healthcare Act 2017: psychosurgery · Multi-stepUnder the Mental Healthcare Act 2017, psychosurgery can be performed only with:
- Mental Healthcare Act 2017: prohibited practices · ApplicationWhich of the following is prohibited as a treatment for mental illness under the Mental Healthcare Act 2017?
- Mental Healthcare Act 2017: Mental Health Review Board · ApplicationThe Mental Health Review Board established under the Act functions mainly to:
- Mental Healthcare Act 2017: right to free treatment · Multi-stepUnder the Mental Healthcare Act 2017, which group is entitled to free mental health care at government establishments?
- Mental Healthcare Act 2017: determination of mental illness · Multi-stepUnder the Act, which of the following may NOT be used as a basis for determining that a person has a mental illness?
Psychotherapy9
- Psychotherapy: learned helplessness · ApplicationIn Seligman's experiments, dogs exposed to inescapable shocks later failed to escape avoidable shocks. This model is applied to explain:
- Psychotherapy: stages of change · ApplicationA smoker who says 'I know I should quit, and I might do so sometime in the next six months' is in which stage of the Prochaska-DiClemente model?
- Psychotherapy: interpersonal therapy · ApplicationInterpersonal therapy for depression focuses on which areas?
- Psychotherapy: countertransference · ApplicationA therapist notices strong irritation and an urge to rescue a particular patient, reminding him of his own father. This reaction is
- Psychotherapy: group therapy factors · ApplicationYalom described therapeutic factors in group therapy. Which is one of them?
- Psychotherapy · ApplicationWhat therapy identifies and changes maladaptive thoughts and behaviors?
- Psychotherapy · ApplicationWhat therapy focuses on links among thoughts, feelings, and behavior?
- Psychotherapy · ApplicationWhat is a core method in cognitive behavioral therapy?
- Psychotherapy: cognitive behavioural therapy · ApplicationWhich intervention is characteristic of cognitive behavioural therapy for depression?
Trauma9
- Trauma: acute stress disorder versus PTSD · ApplicationA survivor of a train accident has intrusive memories, avoidance and hyperarousal beginning 3 days after the event and persisting for 2 weeks. The DSM-5 diagnosis is:
- Trauma: PTSD treatment · Multi-stepFor a patient with PTSD who has recurrent trauma-related nightmares, which statement about treatment is correct?
- Trauma: adjustment disorder · ApplicationA man develops low mood, tearfulness and difficulty working within 2 weeks of losing his job. Full criteria for major depression are not met. The diagnosis is:
- Trauma: prolonged grief disorder · Multi-stepIn ICD-11, prolonged grief disorder is diagnosed when intense yearning for the deceased with emotional pain persists beyond a minimum of:
- Trauma: prazosin for nightmares · Multi-stepA veteran with PTSD on sertraline continues to have distressing trauma-related nightmares. Which drug is often added for this symptom?
- Trauma: EMDR · ApplicationIn which disorder is eye movement desensitisation and reprocessing an established psychological treatment?
- Trauma: psychological debriefing · Multi-stepAfter a bus accident, survivors are offered single-session compulsory psychological debriefing to prevent PTSD. What does the evidence show?
- Trauma: enduring personality change · Multi-stepIn ICD-10, a person who survived years in a concentration camp shows a hostile distrust of the world, social withdrawal and chronic feeling of emptiness for more than t…
- Trauma · ApplicationSymptoms within first month after trauma may be what?
Capacity8
- Capacity: decision-making · ApplicationIn assessing a patient's decision-making capacity to refuse treatment, which of the following is NOT a component?
- Capacity · ApplicationCapacity requires ability to do what?
- Capacity · ApplicationCapacity may change with what?
- Capacity · ApplicationWhat is essential for a patient to have decision-making capacity?
- Capacity · ApplicationWhat is a core element of informed consent?
- Capacity · ApplicationWhat capacity ability requires comparing consequences of options?
- Capacity · ApplicationWhich ability is needed for decision-making capacity?
- Capacity · ApplicationWhat is the appropriate approach when capacity is uncertain?
Obsessive-compulsive disorder8
- Obsessive-compulsive disorder · ApplicationWhat is an obsession?
- Obsessive-compulsive disorder · ApplicationWhat is a compulsion?
- Obsessive-compulsive disorder · ApplicationWhat treatment approach is commonly used for obsessive-compulsive disorder?
- Obsessive-compulsive disorder · ApplicationWhat differentiates an obsession from a delusion?
- Obsessive-compulsive disorder · ApplicationWhat is a compulsion?
- Obsessive-compulsive disorder: treatment · ApplicationA patient repeatedly washes her hands to reduce distress from contamination obsessions. Which psychotherapy has the strongest disorder-specific evidence as a first-line…
- Obsessive-compulsive disorder · ApplicationA patient repeatedly checks a locked door to neutralise intrusive fears of harming the family. The checking behaviour is a what?
- Obsessive-compulsive disorder · ApplicationWhat are compulsions?
Psychodynamics8
- Psychodynamics · ApplicationA man humiliated by his supervisor says nothing at work, but shouts at his wife and children when he reaches home. Which defence mechanism is operating?
- Psychodynamics: defence mechanisms (reaction formation) · ApplicationA woman who unconsciously resents her mother-in-law behaves in an excessively warm and caring way towards her. The defence mechanism is:
- Psychodynamics: displacement · ApplicationA man scolded by his boss comes home and shouts at his children over a trivial matter. The defence mechanism is:
- Psychodynamics: splitting · Multi-stepA patient praises one nurse as perfect and condemns another as completely evil, changing views abruptly after small disappointments. This defence is:
- Psychodynamics: projective identification · Multi-stepA borderline patient who feels unconsciously angry accuses the therapist of being hostile and behaves provocatively until the therapist actually feels irritated. This d…
- Psychodynamics: undoing and isolation · ApplicationA man who has aggressive thoughts about his wife recalls the thoughts calmly without any feeling, as if describing someone else. This defence is
- Psychodynamics: identification with the aggressor · ApplicationA boy bullied by his father starts bullying younger children in the same manner. This defence is
- Psychodynamics: mature defences · ApplicationWhich pair of defence mechanisms is classed as mature in Vaillant's hierarchy?
Trauma disorders7
- Trauma disorders · ApplicationWhat symptom is characteristic of post-traumatic stress disorder?
- Trauma disorders · ApplicationWhat duration separates post-traumatic stress disorder from acute stress reaction in standard classification?
- Trauma disorders · ApplicationWhat avoidance pattern may occur in post-traumatic stress disorder?
- Trauma disorders · ApplicationWhat symptom cluster is typical of post-traumatic stress disorder?
- Trauma disorders · ApplicationWhich symptom is characteristic of PTSD?
- Trauma disorders: acute stress disorder · ApplicationNine days after a serious road traffic collision, a patient has intrusive memories, avoidance, hypervigilance, and dissociative symptoms. Which diagnosis best fits if s…
- Trauma disorders · ApplicationWhich symptom is part of post-traumatic stress disorder?
Culture-bound syndromes6
- Culture-bound syndromes: Dhat · ApplicationA young Indian man complains of weakness, fatigue and anxiety, and believes that semen passes in his urine, causing loss of vitality. This culture-bound syndrome is:
- Culture-bound syndromes: Koro · ApplicationA man in southeast Asia suddenly develops intense anxiety that his penis is shrinking into his abdomen and that he will die. The syndrome is:
- Culture-bound syndromes: amok · ApplicationA young Malay man, after brooding over an insult, suddenly goes on a violent rampage attacking people, followed by amnesia. This syndrome is
- Culture-bound syndromes: brain fag · ApplicationA West African student preparing for exams complains of head and neck pressure, burning sensations, blurred vision and inability to retain what he reads. This is
- Culture-bound syndromes: ataque de nervios · Multi-stepA Latin American woman, after her brother's funeral, screams, trembles, has chest heat rising to the head and collapses, with subsequent amnesia but rapid recovery. Thi…
- Culture-bound syndromes: hwa-byung · Multi-stepA middle-aged Korean woman describes a sensation of a mass in the epigastrium, heat rising, palpitations and insomnia after years of suppressing anger at her husband. T…
Delirium6
- Delirium · ApplicationWhat feature distinguishes delirium from many chronic disorders?
- Delirium · ApplicationWhat intervention is useful in preventing delirium in vulnerable inpatients?
- Delirium · ApplicationWhat is a common reversible cause to check in delirium?
- Delirium · ApplicationWhat feature distinguishes delirium from dementia?
- Delirium · ApplicationWhat feature best distinguishes delirium from dementia?
- Delirium · ApplicationAn older inpatient develops fluctuating attention, disorientation and visual misperceptions over hours. What is the most likely syndrome?
Dissociative disorders6
- Dissociative disorders: depersonalisation · ApplicationA 24-year-old student describes feeling detached from his body, as if watching himself from outside, while knowing it is not real. This is:
- Dissociative disorders: dissociative identity disorder · ApplicationA woman has two or more distinct personality states that recurrently take control of her behaviour, with gaps in recall of everyday events. She has a history of severe…
- Dissociative disorders: dissociative fugue · ApplicationA 35-year-old man is found in a distant city with no recall of his name or past. He had left home suddenly after a financial disaster and set up a new life. The amnesia…
- Dissociative disorders: dissociative amnesia · ApplicationA 28-year-old man is found well but cannot recall his name or events of the past week after witnessing a murder. Neurological examination and CT are normal. Which is th…
- Dissociative disorders: possession · ApplicationA young woman at a village festival suddenly speaks in a different voice and claims to be a goddess, with later amnesia. This is accepted within her culture. How is it…
- Dissociative disorders · ApplicationAfter a traumatic event, a patient cannot recall important autobiographical details about the event, although examination and imaging show no neurological cause. Which…
Forensic psychiatry6
- Forensic psychiatry: legal insanity · Multi-stepIn Indian law, the defence of unsoundness of mind (formerly Section 84 IPC, now Section 22 of the Bharatiya Nyaya Sanhita) applies when, at the time of the act, the per…
- Forensic psychiatry: fitness to stand trial · Multi-stepAn accused person with schizophrenia is charged with assault. Which capacity is assessed to decide fitness to stand trial?
- Forensic psychiatry: lucid interval · ApplicationA man with recurrent psychosis signs a contract during a period of full recovery with intact understanding. This period is called
- Forensic psychiatry: irresistible impulse · ApplicationIn law, the test that excuses an offender who knew the act was wrong but could not control the impulse due to mental disease is the
- Forensic psychiatry: marriage and mental disorder · ApplicationUnder Indian personal laws, which mental condition can be a ground for annulment or divorce?
- Forensic psychiatry: capacity · Multi-stepA patient can state the proposed operation but cannot explain in their own words the material risks, benefits, or alternatives, even after support is provided. Which de…
OCD6
- OCD: clinical features · ApplicationA man washes his hands over 50 times a day because of intrusive thoughts of contamination. He knows this is excessive and tries to resist but feels anxious if he stops.…
- OCD: pharmacotherapy · ApplicationWhich statement about drug treatment of obsessive-compulsive disorder is true?
- OCD: behavioural therapy · ApplicationThe psychological treatment of choice in obsessive-compulsive disorder is:
- OCD: neurobiology · Multi-stepA 9-year-old boy suddenly develops severe obsessions and tics after a streptococcal throat infection. This association is termed:
- OCD · ApplicationRepetitive handwashing to reduce contamination anxiety is what?
- OCD · ApplicationWhat therapy is targeted first-line for OCD?
Somatic disorders6
- Somatic disorders: conversion disorder · ApplicationA 19-year-old woman wakes with sudden weakness of the right leg after an argument with her fiance. Reflexes, tone and imaging are normal, and Hoover sign is positive. T…
- Somatic disorders: somatic symptom disorder · ApplicationA 40-year-old man has multiple chronic bodily complaints, with excessive thoughts and anxiety about them and disproportionate time devoted to health concerns for over 6…
- Somatic disorders: illness anxiety disorder · ApplicationA man is convinced that he has an undiagnosed cancer despite repeated negative tests, and has almost no physical symptoms. He keeps checking his body and seeks repeated…
- Somatic disorders: factitious disorder · ApplicationA nurse repeatedly presents with fever and abdominal pain, and doctors discover she has been injecting herself with faecal material. She gains nothing materially but re…
- Somatic disorders: factitious disorder by proxy · ApplicationA mother repeatedly brings her toddler to hospital with fabricated seizures and has been found adding salt to his feeds. She seems to enjoy attention from staff. What i…
- Somatic disorders: neurasthenia · ApplicationPersistent complaints of mental fatigue after minor effort, with muscle aches, dizziness and inability to relax, are coded in ICD-10 as
Suicidology6
- Suicidology: clozapine · Multi-stepWhich antipsychotic has been shown to reduce suicidal behaviour in patients with schizophrenia or schizoaffective disorder?
- Suicidology: lithium · ApplicationLong-term lithium therapy in mood disorders is notable for reducing:
- Suicidology: prevention · ApplicationWhich public health intervention has the strongest evidence for reducing suicide rates in agricultural populations where self-poisoning is common?
- Suicidology: high-risk period · ApplicationThe period of highest suicide risk for a patient with depression admitted after a suicide attempt is:
- Suicidology: Durkheim's types · ApplicationIn Durkheim's classification, suicide among people who feel excessively integrated into a group and who sacrifice themselves for it, such as a soldier or a sati, is
- Suicidology: Werther effect · ApplicationAfter intense media coverage of a celebrity's suicide by a particular method, a measurable rise in suicides follows in the community. This phenomenon is known as
Catatonia5
- Catatonia · ApplicationA 25-year-old woman is mute, holds an odd posture for hours and resists passive movement, with waxy flexibility. She has refused food for two days. What is the most app…
- Catatonia: malignant catatonia · Multi-stepA patient with schizophrenia and catatonic stupor develops fever, rigidity, autonomic instability and altered sensorium, but has never received an antipsychotic. What i…
- Catatonia: lorazepam challenge · Multi-stepA mute, immobile patient shows posturing and negativism. A 2 mg IV lorazepam test produces marked improvement within minutes. This response
- Catatonia · ApplicationWaxy flexibility and mutism suggest what?
- Catatonia · ApplicationMutism, posturing, waxy flexibility and negativism in severe mood illness are most consistent with what syndrome?
ECT5
- ECT: contraindications · ApplicationWhich condition is considered the most important relative contraindication to ECT?
- ECT: modified technique · ApplicationIn modified ECT, which pair of drugs is used along with the electric stimulus?
- ECT: electrode placement · Multi-stepWhich statement on electrode placement in ECT is correct?
- ECT: course of treatment · ApplicationA typical course of ECT for depression consists of approximately:
- ECT: drugs altering seizure threshold · Multi-stepA patient scheduled for ECT is on lorazepam and the seizure is brief and inadequate. What is the most appropriate action?
Perinatal psychiatry5
- Perinatal psychiatry · ApplicationOn day 4 after delivery of a healthy baby, a 26-year-old woman is tearful, anxious and emotionally labile. She cares for the infant well and has no psychotic symptoms.…
- Perinatal psychiatry: Edinburgh scale · ApplicationThe Edinburgh Postnatal Depression Scale (EPDS) consists of how many items, with a maximum score of 30?
- Perinatal psychiatry: postpartum psychosis · ApplicationA woman 10 days after her first delivery becomes insomniac and perplexed, with delusions about her baby and elevated mood. The most appropriate step is:
- Perinatal psychiatry: antidepressants in lactation · Multi-stepA breastfeeding mother needs an antidepressant for postpartum depression. Which drug is generally preferred because of low infant exposure?
- Perinatal psychiatry: postpartum depression neurosteroid · Multi-stepWhich drug, a positive allosteric modulator of GABA-A receptors and an oral neurosteroid, is approved for postpartum depression?
Psychopharmacology adverse effects5
- Psychopharmacology adverse effects · ApplicationA man with schizophrenia has his haloperidol dose increased. Three days later he is confused with a temperature of 39.5 C, lead-pipe rigidity, labile blood pressure, ta…
- Psychopharmacology adverse effects · Multi-stepA woman on sertraline is given tramadol for pain. Within hours she develops agitation, sweating, diarrhoea, tremor, hyperreflexia and inducible ankle clonus. What is th…
- Psychopharmacology adverse effects · ApplicationA man with bipolar disorder who has taken lithium for years develops marked polyuria and polydipsia with persistently dilute urine, which does not respond to desmopress…
- Psychopharmacology adverse effects · Multi-stepA woman who stopped paroxetine abruptly after missing her tablets for several days complains of dizziness, electric-shock-like sensations, nausea, irritability and inso…
- Psychopharmacology adverse effects: acute dystonia · ApplicationA 19-year-old man given an intramuscular haloperidol injection two hours earlier now has a twisted neck, a clenched jaw and upward deviation of the eyes. He is frighten…
Alzheimer disease4
- Alzheimer disease: genes of early onset · ApplicationA 42-year-old with progressive memory loss has a mother and uncle with dementia in their forties. Which mutation is the commonest cause of such early-onset familial Alz…
- Alzheimer disease: Down syndrome · ApplicationPeople with Down syndrome develop Alzheimer pathology early. This is explained by
- Alzheimer disease: cholinesterase inhibitors · ApplicationA 74-year-old with mild Alzheimer disease is started on donepezil. Which adverse effect should be monitored for?
- Alzheimer disease: memantine · ApplicationMemantine is used in moderate to severe Alzheimer disease. Its mechanism is
Behaviour therapy4
- Behaviour therapy: techniques · ApplicationIn a ward for children with intellectual disability, desirable behaviours are rewarded with tokens that can be exchanged for treats. This technique is based on:
- Behaviour therapy: biofeedback · ApplicationA patient with tension headaches learns to reduce frontalis muscle tension while watching an electromyography display. This technique is
- Behaviour therapy: token economy · ApplicationOn a chronic psychiatry ward, patients earn tokens for self-care and social behaviour that can be exchanged for privileges. This is an application of
- Behaviour therapy: aversion therapy · ApplicationA man with alcohol dependence is given a drug that induces vomiting each time he smells alcohol. This is
Classification4
- Classification: DSM-5 addictive disorders · ApplicationWhich behavioural addiction is included alongside substance use in the DSM-5 chapter 'Substance-Related and Addictive Disorders'?
- Classification: ICD-11 innovations · ApplicationWhich of the following is a new diagnosis introduced in ICD-11 and distinct from PTSD?
- Classification: DSM-5 changes · ApplicationWhich change was made in DSM-5 compared with DSM-IV-TR?
- Classification: ICD-11 gaming disorder · ApplicationIn ICD-11, gaming disorder is classified under
Community psychiatry4
- Community psychiatry: levels of prevention · ApplicationEarly detection and prompt treatment of first-episode psychosis to reduce duration of untreated illness is an example of:
- Community psychiatry: National Mental Health Programme · ApplicationThe National Mental Health Programme of India was launched in which year?
- Community psychiatry: mhGAP · ApplicationWhich WHO programme provides evidence-based guidance to scale up care for mental, neurological and substance use disorders by non-specialist health workers in low-resou…
- Community psychiatry: sheltered workshop · ApplicationA man with chronic schizophrenia in remission works at simple tasks in a supervised environment with flexible hours and support. This component of rehabilitation is
Development4
- Development: Erikson stages · ApplicationAccording to Erikson, the psychosocial crisis of school age (about 6 to 12 years) is:
- Development: Ainsworth strange situation · ApplicationIn Ainsworth's strange situation, an infant who is distressed on separation but is easily comforted on the mother's return and then resumes play shows which attachment…
- Development: Kohlberg's moral development · ApplicationA 10-year-old does not steal because he fears punishment, and obeys rules to avoid getting caught. In Kohlberg's scheme, this is which level?
- Development: Mahler's separation-individuation · Multi-stepA toddler of 18 months alternates between clinging to the mother and pushing her away, wanting both closeness and independence. In Mahler's scheme, this subphase is
Ethics4
- Ethics · ApplicationWhen may confidentiality be limited?
- Ethics · ApplicationWhat principle permits sharing confidential information when there is a serious imminent safety risk?
- Ethics · ApplicationWhen may confidentiality be limited in mental-health care?
- Ethics · ApplicationWhen can psychiatric confidentiality be limited?
Medical mimics4
- Medical mimics: steroid-induced psychiatric effects · ApplicationA patient started on high-dose prednisolone for lupus becomes euphoric, sleepless and grandiose within a week. The probable diagnosis is:
- Medical mimics: hypothyroidism · ApplicationA middle-aged woman with severe hypothyroidism develops paranoid delusions and hallucinations with slowed thinking. This is called:
- Medical mimics: interferon · Multi-stepA patient treated with pegylated interferon alpha for hepatitis C develops marked depressive symptoms with suicidal thoughts. The best management is:
- Medical mimics: acute intermittent porphyria · Multi-stepA young woman has recurrent episodes of severe abdominal pain, anxiety, hallucinations and dark urine after a barbiturate. The most probable underlying disease is:
MSE4
Neurocognitive disorders4
- Neurocognitive disorders: Lewy body disease · Multi-stepAn older patient has fluctuating cognition, recurrent well-formed visual hallucinations, REM sleep behavior disorder, and spontaneous parkinsonism. Which major neurocog…
- Neurocognitive disorders: delirium · ApplicationA postoperative older adult becomes disoriented overnight, cannot recite the months backward, and alternates between drowsiness and agitation. Which feature is most cen…
- Neurocognitive disorders · ApplicationWhat is a core feature of dementia?
- Neurocognitive disorders · ApplicationWhich feature is common in Lewy body dementia?
Psychiatric emergencies4
- Psychiatric emergencies · ApplicationWhat is the safest response to escalating agitation with risk of violence?
- Psychiatric emergencies: catatonia · Multi-stepA severely depressed patient is mute, negativistic, holds an unusual posture for long periods, and has waxy flexibility. After medical assessment, which bedside medicat…
- Psychiatric emergencies · ApplicationWhat is the immediate priority when a patient expresses active suicidal intent with a plan?
- Psychiatric emergencies · ApplicationWhat syndrome can follow abrupt cessation of benzodiazepines after long-term use?
Psychology4
- Psychology: operant reinforcement schedule · Multi-stepGamblers continue to play slot machines for hours despite repeated losses, as rewards come after an unpredictable number of plays. Which reinforcement schedule explains…
- Psychology: Thematic Apperception Test · ApplicationWhich test, devised by Murray and Morgan, asks the person to make up stories about ambiguous pictures, revealing needs and conflicts?
- Psychology: MMPI · ApplicationThe Minnesota Multiphasic Personality Inventory includes validity scales such as L, F and K. What is their purpose?
- Psychology: Wechsler intelligence scales · ApplicationThe Wechsler Adult Intelligence Scale yields
Anxiety3
Delusional syndromes3
- Delusional syndromes: Othello · ApplicationA 50-year-old alcohol-dependent man repeatedly accuses his wife of an affair, searching her clothes and bags despite no evidence. The most likely term is:
- Delusional syndromes: erotomania · ApplicationA 35-year-old woman is convinced that a famous film director secretly loves her and sends her coded messages, although they have never met. This is:
- Delusional syndromes: Cotard · Multi-stepA severely depressed 60-year-old woman says her intestines have rotted away and that she is already dead and cannot die. What is this syndrome called?
Depressive disorders3
- Depressive disorders: premenstrual dysphoric disorder · ApplicationA woman has marked irritability, mood lability and depressed mood in the week before every menstrual period, which remit soon after menses begin. DSM-5 diagnosis is:
- Depressive disorders: disruptive mood dysregulation · Multi-stepAn 8-year-old has severe temper outbursts three or more times a week, grossly out of proportion to the trigger, with persistently irritable mood between outbursts for o…
- Depressive disorders: bereavement · ApplicationFourteen months after her spouse died, an adult remains intensely preoccupied with the deceased, avoids reminders of the death, and cannot resume work. Her reaction cle…
Dissociative and somatic disorders3
- Dissociative and somatic disorders · ApplicationA 20-year-old woman develops sudden paralysis of both legs the day after a bitter quarrel with her family. Neurological examination and MRI are normal, and she seems un…
- Dissociative and somatic disorders · ApplicationA nurse repeatedly presents with fever and abscesses. It is later discovered that she secretly injects herself with contaminated material. She has no apparent external…
- Dissociative and somatic disorders: primary and secondary gain · ApplicationA soldier develops paralysis of the arm before a combat mission, which relieves his anxiety about fighting. This relief of anxiety by the symptom is
Formal thought disorder3
- Formal thought disorder: derailment · ApplicationA patient with schizophrenia says, 'I went to the market. Politics is a game of birds. The colour blue is expensive.' The ideas slip between unrelated topics without a…
- Formal thought disorder: circumstantiality · ApplicationAsked what time he reached the clinic, a patient describes his bus route, the weather, the shop he passed and his neighbour's illness before finally answering. This is:
- Formal thought disorder: perseveration · ApplicationA patient with a frontal lobe lesion keeps giving the answer 'pen' to every question after being first shown a pen, whatever the new object. This is:
Geriatric psychiatry3
- Geriatric psychiatry: late-onset psychosis · Multi-stepA 72-year-old woman living alone with long-standing deafness develops a well-organised persecutory delusion and auditory hallucinations, with preserved personality and…
- Geriatric psychiatry: Charles Bonnet syndrome · Multi-stepAn 80-year-old with severe macular degeneration sees vivid, well-formed images of people and animals, and knows they are not real. She has no other psychiatric symptoms…
- Geriatric psychiatry: Diogenes syndrome · ApplicationA 78-year-old widower living alone in a filthy house with accumulated rubbish, severe self-neglect and refusal of help, who shows no shame, has
Medication3
Neurodevelopment3
Rating scales3
- Rating scales: CIWA-Ar · ApplicationThe Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar), guides:
- Rating scales: MoCA · ApplicationCompared with the MMSE, the Montreal Cognitive Assessment (MoCA) is more sensitive for detecting:
- Rating scales: Young Mania Rating Scale · ApplicationWhich rating scale is administered by a clinician to measure severity of manic symptoms?
Sexual disorders3
- Sexual disorders: gender incongruence · ApplicationIn ICD-11, gender incongruence has been moved out of the mental disorders chapter into:
- Sexual disorders: erectile dysfunction · ApplicationA 28-year-old man cannot sustain an erection with his partner but has normal morning erections and can masturbate normally. The most likely cause is:
- Sexual disorders: sensate focus · ApplicationA couple with erectile difficulty from performance anxiety are taught graded touching exercises that exclude intercourse initially. This technique is
Somatic treatments3
Suicide risk3
Bipolar disorder2
Clozapine2
- Clozapine: seizures · ApplicationA patient on clozapine 600 mg per day has a generalised seizure. Which statement is correct?
- Clozapine: constipation · Multi-stepA patient on clozapine develops abdominal distension, vomiting and absent bowel sounds after weeks of severe constipation. What is the concern?
Conversion disorder2
- Conversion disorder: Hoover sign · Multi-stepIn a patient with functional leg weakness, the examiner places a hand under the heel of the weak leg and asks the patient to lift the other leg against resistance. Down…
- Conversion disorder: psychogenic nonepileptic seizures · Multi-stepWhich feature favours a psychogenic nonepileptic seizure over an epileptic seizure?
Delusional misidentification2
- Delusional misidentification: Capgras · ApplicationA woman insists that her husband has been replaced by an identical impostor and refuses to live with him, though she admits he looks exactly the same. This is:
- Delusional misidentification: Fregoli · Multi-stepA patient believes that a single persecutor follows him by changing disguises, appearing as the postman, the doctor and the shopkeeper. This is:
Depression2
Disability law2
- Disability law: RPwD Act 2016 · ApplicationThe Rights of Persons with Disabilities Act 2016 recognises how many categories of disability, including mental illness, autism and specific learning disability?
- Disability law: benchmark disability · Multi-stepIn the RPwD Act 2016, a 'person with benchmark disability' is one with a certified disability of at least:
Hypnotics2
Mood2
National mental health services2
- National mental health services: Tele-MANAS · ApplicationThe toll-free national tele-mental health service launched in 2022 under the Government of India's initiative is:
- National mental health services: DMHP · Multi-stepThe District Mental Health Programme (DMHP) in India was launched in 1996 as part of which programme, itself started in 1982?
Obsessive-compulsive related disorders2
- Obsessive-compulsive related disorders: hoarding · ApplicationAn elderly man cannot discard old newspapers and broken items, and his rooms are so cluttered that they cannot be used for their purpose. In DSM-5 this is:
- Obsessive-compulsive related disorders: trichotillomania · ApplicationA 15-year-old girl repeatedly pulls out her scalp hair, resulting in patchy hair loss, and has been unable to stop. The best behavioural treatment is:
OCD-related2
- OCD-related: body dysmorphic disorder · ApplicationA 22-year-old of normal appearance spends hours daily checking and camouflaging his nose, which he believes is grotesquely deformed. He seeks repeated cosmetic surgery.…
- OCD-related: excoriation disorder · ApplicationA 24-year-old woman repeatedly picks at her facial skin for hours, causing sores, and fails to stop despite repeated attempts. The diagnosis is
Organic brain syndromes2
- Organic brain syndromes · Multi-stepA malnourished man with chronic alcohol dependence is brought in confused, with an unsteady gait and nystagmus with ophthalmoplegia. He is hypoglycaemic. What is the mo…
- Organic brain syndromes · Multi-stepA 74-year-old man has fluctuating cognition, well-formed visual hallucinations of children in the room and mild parkinsonism. After haloperidol is given for agitation h…
Personality2
Sleep2
Substance2
Therapy2
Anxiety, obsessive-compulsive, and trauma-related disorders1
Electroconvulsive therapy1
Mental health law1
Mental-state examination1
Mood stabilizers1
Neuromodulation1
Personality, substance use, and eating disorders1
Psychiatric foundations and classification1
Risk assessment1
Serotonin syndrome1
Somatic symptom and related disorders1
Somatic symptom disorders1
Suicide assessment1
Suicide risk assessment1
Common questions
How many Psychiatry questions are there?
933 original questions across 747 topics, and the bank grows over time.
Which Psychiatry topics are covered?
Psychopharmacology, Psychotic disorders, Organic psychiatry, Eating disorders, Substance use, Anxiety disorders, Psychodynamics, Child psychiatry, Sleep disorders, Somatic symptom and related disorders, Perinatal psychiatry, Psychopathology, and more.
How difficult are these Psychiatry questions?
0 are recall, 698 are application and 235 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Psychiatry questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Psychiatry for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Psychiatry test?
Yes. The Psychiatry subject test is included with a paid term, with a countdown and a question palette.
How should I use these Psychiatry questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Psychiatry questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.