pgi mock

1. 1. Which of the following are panic inducing substances?

a. Oxygen

b. Carbon dioxide

c. Nicotine

d. Caffeine

e. Clonidine

2. 2.Defence mechanisms involved in phobic disorders are

a. Reaction formation

b. Avoidance

c. Projection

d. Undoing

e. Displacement

3. 3.Poor prognostic factors in OCD are

a. Episodic nature of symptoms

b. Childhood onset

c. Delusional beliefs

d. Presence of precipitating event

e. Yielding compulsions

4. 4.True about factitious disorder are

a. Symptom production intentional

b. Symptom production conscious

c. External incentives primary motivation for behaviour

d. Manchusen syndrome have predominantly psychological symptoms.

e. Manchusen syndrome more common in males.

5. 5. Pharmacological agents used in treatment of sexual dysfunction are

a. Epinephrine

b. Phentolamine

c. Morphine

d. Apomorphine

e. Alprostadil

6. 6.Which of the following is/are associated with NREM sleep

a. Presence of poikilothermia

b. Most physiological functions are markedly lower than in wakefulness

c. Nightmares

d. Night terror

e. Accompanied by a partial or full penile erection.

7. 7.Which of the following are medical complications of anorexia nervosa

a. Menorrhagia

b. Hypermagnesia

c. Hypokalemia

d. Osteoporosis

e. Seizures

8. 8.Which of the following are impulse control disorders

a. Dipsomania

b. Intermittent explosive disorder

c. Kleptomania

d. Trichotillomania

e. Megalomania

9. 9.Which of the following are cluster B personality disorders

a. Schizotypal personality disorder

b. Antisocial personality disorder

c. Dependent personality disorder

d. Obsessive compulsive personality disorder

e. Borderline personality disorder

10. 10.Which of the following neurolept induced movement disorders are more likely to occur in females compared to males?

a. Acute dystonia

b. Acute akathasia

c. Tardive dyskinesia

d. Neurolpt malignant syndrome

e. Neurolept induced parkinsonism

11. 11.True about eneuresis is/are

a. More common in boys

b. Most commonly due to neurological causes

c. Operant conditioning is the treatment of choice

d. Oral desmopressin used in treatment

e. The diagnosis not made until the chronologic and developmental age of 5 years.

12. 12.Which of the following are declarative memory

a. Semantic

b. Episodic

c. Procedural

d. Priming

e. Conditioning

13. 13. Which of the following are potentially reversible causes of dementia?

a. Dementia puglistica

b. Hypothyroidism

c. Alzeimers disease

d. Wernicke’s encephalopathy

e. Normal pressure hydrocephalus

14. 14.Which of the following are melanocholic symptoms of depression?

a. Depression regularly worse in the evening.

b. Significant weight gain

c. Excessive guilt

d. lack of reactivity to usually pleasurable stimuli

e. Easy fatiguability

15. 15. Which of the following are true about schizophrenia

a. Lifetime prevalence is about 1 percent.

b. Equally prevalent in men and women.

c. Persons who develop schizophrenia are more likely to have been born in the late spring and summer

d. Higher mortality rate from accidents & natural causes than general population.

e. The most prevalent substance use is alcohol among schizophrenic patients.

Solutions

1. Which of the following are panic inducing substances?

a. Oxygen

b. Carbon dioxide

c. Nicotine

d. Caffeine

e. Clonidine

Ans b. Carbon dioxide d. Caffeine

· Panic-Inducing Substances (panicogens)

o Carbon dioxide (5 to 35 percent mixtures), sodium lactate, and bicarbonate

o Yohimbine, an œ₂-adrenergic receptor antagonist

o m-chlorophenylpiperazine (mCPP)

o m-Caroline drugs (GABA_B receptor inverse agonists)

o Flumazenil (GABA_B receptor antagonist)

o Cholecystokinin

o Caffeine.

· Panic disorder:

o recurrent unexpected panic attacks

o at least one of the attacks has been followed by ≥1 month of ≥ 1 of the following:

§ persistent concern about having additional attacks

§ worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, going crazyâ)

§ a significant change in behavior related to the attacks

2. Defence mechanisms involved in phobic disorders are

a. Reaction formation

b. Avoidance

c. Projection

d. Undoing

e. Displacement

Ans b. Avoidance c. Projection e. Displacement

v Principal defense mechanisms include displacement, projection, and avoidance.

Ø Displacement:

§ Shifting an emotion or drive cathexis from one idea or object to another that resembles the original in some aspect or quality.

§ Permits the symbolic representation of the original idea or object by one that is less highly cathected or evokes less distress.

Ø Avoidance

Ø Projection: Perceiving and reacting to unacceptable inner impulses and their derivatives as though they were outside the self.

Ø Reaction formation: Transforming an unacceptable impulse into its opposite.

Ø Undoing: Compulsive act, performed to prevent or undo the results that the patient irrationally anticipates from a frightening obsessional thought or impulse.

3. Poor prognostic factors in OCD are

a. Episodic nature of symptoms

b. Childhood onset

c. Delusional beliefs

d. Presence of precipitating event

e. Yielding compulsions

Ans b. Childhood onset c. Delusional belief e. Yielding compulsions

· Poor prognosis is indicated by

o Yielding to (rather than resisting) compulsions

o Childhood onset

o Bizarre compulsions

o Need for hospitalization

o Coexisting major depressive disorder,

o Delusional beliefs

o Presence of overvalued ideas

o Presence of a personality disorder (especially schizotypal personality disorder).

· Good prognosis is indicated by

o good social and occupational adjustment

o the presence of a precipitating event

o An episodic nature of the symptoms.

· The obsessional content does not seem to be related to the prognosis.

4. True about factitious disorder are

a. Symptom production intentional

b. Symptom production conscious

c. External incentives primary motivation for behaviour

d. Manchusen syndrome have predominantly psychological symptoms.

e. Manchusen syndrome more common in males.

Ans. A. Symptom production intentional b. Symptom production conscious e. Manchusen syndrome more common in males.

Factitious disorder

· Intentional production or feigning of physical or psychological signs or symptoms.

· The motivation for the behavior is to assume the sick role.

· External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in malingering) are absent.

· Types

Ø With predominantly psychological signs and symptoms

Ø With predominantly physical signs and symptoms (Munchausen syndrome, hospital addiction, polysurgical addiction”producing the so-called washboard abdomen, and professional patient syndrome)

Factitious Disorder by Proxy

· Intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care.

5. Pharmacological agents used in treatment of sexual dysfunction are

a. Epinephrine

b. Phentolamine

c. Morphine

d. Apomorphine

e. Alprostadil

Ans b. Phentolamine d. Apomorphine e. Alprostadil

· Sildenafil

o Nitric oxide enhancer that facilitates the inflow of blood to the penis necessary for an erection.

o Takes effect about 1 hour after ingestion, and its effect can last up to 4 hours.

o Not effective in the absence of sexual stimulation.

o Most common adverse events are headaches, flushing, and dyspepsia.

o Contraindicated for persons taking organic nitrates.

o Nonarteritic Ischemic Optic Neuropathy (NAION) reported soon after use in some pts.

· Phentolamine

o Reduces sympathetic tone and relaxes corporeal smooth muscle.

o Adverse events: hypotension, tachycardia and dizziness.

· Apomorphine

o Effects are mediated by ANS and result in vasodilatation that facilitates the inflow of blood to the penis.

o Adverse events: nausea and sweating.

· Injectable and transurethral alprostadil

o Contains a naturally occurring form of prostaglandin E, a vasodilating agent.

o Act locally on the penis and can produce erections in the absence of sexual stimulation.

o Firm erection produced within 2 to 3 minutes after administration of the drug may last as long as 1 hour.

o Adverse effects of injections: penile bruising and changes in liver function test results.

o Possible hazardous sequelae: priapism and sclerosis of the small veins of the penis.

6. Which of the following is/are associated with NREM sleep

a. Presence of poikilothermia

b. Most physiological functions are markedly lower than in wakefulness

c. Nightmares

d. Night terror

e. Accompanied by a partial or full penile erection.

Ans b. Most physiological functions are markedly lower than in wakefulness. D. Night terror

• Non-rapid eye movement (NREM) sleep
• Composed of stages 1 through 4
• Most physiological functions are markedly lower than in wakefulness.
• Pulse rate is typically slowed 5-10 beats/min and is very regular.
• Respiration & BP tends to be low, with few minute-to-minute variations.
• Episodic, involuntary body movements are present.
• Blood flow of most tissues including cerebral blood flow is slightly reduced.
• Deepest portions stages 3 and 4 are associated with unusual arousal characteristics.
• Disoriented and thinking disorganized when aroused.
• Associated with amnesia for events that occur
• Dreaming does occur, but is typically lucid and purposeful.
• May result in specific problems: enuresis, somnambulism & night terrors.
• Rapid eye movement (REM) sleep
• Physiologically similar to waking (known as paradoxical sleep)
• Pulse, respiration, and blood pressure in humans are all high and often higher than during waking with high min-min variability.
• Brain oxygen use increases during REM sleep.
• Ventilatory response to increased levels of carbon dioxide (CO₂) is depressed
• Altered thermoregulation: Poikilothermia (a state in which animal temperature varies with the changes in the temperature of the surrounding medium) prevails.
• Accompanied by a partial or full penile erection.
• Near-total paralysis of the skeletal (postural) muscles; No body movements.
• Persons awakened report dreaming which are typically abstract and surreal.
• REM latency
• About 90 minutes after sleep onset, NREM yields to the 1st REM of night.
• Shortening of REM latency occurs with depressive disorders and narcolepsy

7. Which of the following are impulse control disorders

a. Dipsomania

b. Intermittent explosive disorder

c. Kleptomania

d. Trichotillomania

e. Megalomania

Ans. B. Intermittent explosive disorder c. Kleptomania d. Trichotillomania

Impulse-Control Disorders

· Characterized by the inability to resist an intense impulse, drive, or temptation to perform a particular act that is obviously harmful to self or others, or both.

· Before the event, the individual usually experiences mounting tension and arousal, sometimes but not consistently mingled with conscious anticipatory pleasure.

· Completing the action brings immediate gratification and relief.

· Within a variable time afterward, the individual experiences a conflation of remorse, guilt, self-reproach, and dread.

o stem from obscure unconscious conflicts or awareness of deed's impact on others

· Category comprises of

o intermittent explosive disorder

o kleptomania

o pyromania

o pathological gambling

o Trichotillomania

8. Which of the following are cluster B personality disorders

a. Schizotypal personality disorder

b. Antisocial personality disorder

c. Dependent personality disorder

d. Obsessive compulsive personality disorder

e. Borderline personality disorder

Ans b. Antisocial personality disorder e. Borderline personality disorder

· Personality disorder subtypes classified in DSM-IV-TR are

o Cluster A: schizotypal, schizoid, and paranoid

o Cluster B: narcissistic, borderline, antisocial, and histrionic

o Cluster C : obsessive-compulsive, dependent, and avoidant.

9. Which of the following neurolept induced movement disorders are more likely to occur in females compared to males?

a. Acute dystonia

b. Acute akathasia

c. Tardive dyskinesia

d. Neurolpt malignant syndrome

e. Neurolept induced parkinsonism

Ans. b. Acute akathasia c. Tardive dyskinesia e. Neurolept induced parkinsonism

Medication-Induced Movement Disorders

v Neuroleptic-Induced Parkinsonism

Ø Symptoms: muscle stiffness (lead pipe rigidity), cogwheel rigidity, shuffling gait, stooped posture, and drooling.

Ø rabbit syndrome: a tremor affecting the lips and perioral muscles, is another parkinsonian effect seen with antipsychotics

Ø occur in about 15 percent of patients who are treated with antipsychotics, usually within 5 to 90 days of the initiation of treatment

Ø Elderly and female are at the highest risk.

Ø Caused by the blockade of dopamine type 2 (D₂) receptors in the caudate at the termination of the nigrostriatal dopamine neurons.

Ø High potency typical antipsychotics more likely to cause these symptoms.

Ø Treatment: Anticholinergic agents

v Neuroleptic-Induced Acute Dystonia

Ø Dystonias are brief or prolonged contractions of muscles that result in obviously abnormal movements or postures, including oculogyric crises, tongue protrusion, trismus, torticollis, laryngeal, pharyngeal dystonias, and dystonic postures of the limbs and trunk.

Ø Children are particularly likely to evidence opisthotonos, scoliosis, lordosis, and writhing movements.

Ø Higher incidence in men, in patients younger than age 30 years, and in patients given high dosages of high-potency medications (particularly intramuscular use) .

Ø Mechanism of action : dopaminergic hyperactivity in the basal ganglia that occurs when central nervous system (CNS) levels of the antipsychotic drug begin to fall between doses.

Ø Treatment with intramuscular anticholinergics or intravenous or intramuscular diphenhydramine (50 mg) almost always relieves the symptoms.

v Neuroleptic-Induced Acute Akathisia

Ø Akathisia is subjective feelings of restlessness, objective signs of restlessness, or both.

Ø Associated with the use antipsychotics, antidepressants, and sympathomimetics.

Ø Middle-aged women are at increased risk

Ø Treatment: reducing medication dosage, attempting treatment with appropriate drugs, and considering changing the neuroleptic.

Ø Most efficacious drugs are ß-adrenergic receptor antagonists, although anticholinergic drugs, benzodiazepines, and cyproheptadine (Periactin) may benefit

v Tardive dyskinesia

Ø is a delayed effect of antipsychotics

Ø rarely occurs until after 6 months of treatment

Ø Abnormal, involuntary, irregular choreoathetoid movements of the muscles of the head, limbs, and trunk.

Ø Dyskinesia is exacerbated by stress and disappears during sleep.

Ø Develops in about 10 -20 percent of patients who are treated for more than a year.

Ø Women, children, patients who are more than 50 years of age, and patients with brain damage or mood disorders are at higher risk.

Ø The atypical antipsychotics are associated with less tardive dyskinesia than the older antipsychotics. Clozapine is the only antipsychotic to have minimal risk of tardive dyskinesia, and can even help improve preexisting symptoms of tardive dyskinesia.

v Neuroleptic Malignant Syndrome

Ø Life-threatening complication that can occur anytime during course of antipsychotic Rx.

Ø Young men are more at risk

Ø Prevalence: 0.02 to 2.4% with typical antipsychotics

Ø Symptoms usually evolve over 24 to 72 hours, and untreated syndrome lasts 10 to 14 days.

Ø Motor & behavioral symptoms: muscular rigidity and dystonia, akinesia, mutism, obtundation, and agitation.

Ø Autonomic symptoms: high fever, sweating, and increased pulse and blood pressure.

Ø Laboratory findings: Increased white blood cell count and increased levels of creatinine phosphokinase, liver enzymes, plasma myoglobin, and myoglobinuria, occasionally associated with renal failure.

Ø Mortality rate: 10-20%.

Ø Treatment

§ Amantadine, bromocriptine, levodopa/carbidopa and dantrolene commonly used

§ Electroconvulsive therapy and BZD effective when other agents have failed

§ Supportive measures (IV hydration, cooling blankets, ice packs, ice-water enema, oxygenation, antipyretics) are often effective as initial approach early in episode

10. True about eneuresis is/are

a. More common in boys

b. Most commonly due to neurological causes

c. Operant conditioning is the treatment of choice

d. Oral desmopressin used in treatment

e. The diagnosis not made until the chronologic and developmental age of 5 years.

Ans. A. More common in boys e. The diagnosis not made until the chronologic and developmental age of 5 years.

Enuresis

Ø Prevalence of enuresis decreases with increasing age.

Ø diagnosis is not made until the chronologic and developmental age of 5 years.

Ø Most children do not exhibit neurological conditions that account for the symptoms.

Ø most severe form of dysfunctional voiding is called Hinman's syndrome

§ due to non-neurogenic neurogenic bladder resulting from habitual, voluntary tightening of the external sphincter during urges to urinate.

Ø Treatment

§ Behavior therapy: Classic conditioning with the bell (or buzzer) and pad apparatus is most effective treatment

§ Pharmacological: Imipramine and desmopressin intrnasal spray.

11. Which of the following are declarative memory

a. Semantic

b. Episodic

c. Procedural

d. Priming

e. Conditioning

Ans: a. Semantic b. Episodic

Declarative Memory

· Semantic memory

Ø knowledge about the world; generic information that is acquired across many different contexts and accessed without accompanying details of the time when the words or facts were remembered

Ø One's vocabulary and knowledge of the associations between verbal concepts make up the bulk of semantic memory.

Ø Cortical association areas involved in storage

Ø Semantic memory loss seen in bilateral anterior temporal dysfunction, limbic encephalitis and herpes simplex encephalitis.

· Episodic memory

Ø Recollection of unique personal experiences

Ø the person reexperiences the sights, sounds, smells, and other details of a specific event.

Ø Key structures involved with episodic memory include the hippocampus, entorhinal cortex, mammillary bodies, and thalamus (medial temporal lobe and neocortex).

Ø Alzeimer’s disease, metabolic and vascular insults, tumours of temporal lobe, infections( HSE) , korsakoff’s syndrome can lead to loss of episodic memory

Non-declarative memory

· heterogeneous collection of nonconscious memory abilities

Ø Procedural learning

§ describes the formation of skills and habits.

§ long-lasting and reliable

§ basal ganglia is fundamental in motor skill learning, while the cerebellum is involved in the association of a visual cue with a motor action.

§ Parkinson's disease (PD) causes damage to the basal ganglia and is associated with impairments in habit learning but spares declarative memory.

Ø Priming: Role of neocortex

Ø Conditioning: Role of amygdale

Ø Non associative learning: Reflex pathways

12. Which of the following are potentially reversible causes of dementia?

a. Dementia puglistica

b. Hypothyroidism

c. Alzeimers disease

d. Wernicke’s encephalopathy

e. Normal pressure hydrocephalus

Ans. B. Hypothyroidism d. Wernicke’s encephalopathy e. Normal pressure hydrocephalus

Potential reversible causes of dementia

· Alcoholism, Drug/medication intoxication

· Wenicke’s encephalopathy, Pernicious anaemia, Pallegra

· Hypothyroidism, Cushings disease, Hypo and Hyperparathyroidism

· Renal/liver/pulmonary failure

· Neurosyphilis, Whipple’s disease, Tuberculosis, fungal, protozoal

· Chronic subdural hematoma, Normal pressure hydrocephalus

· Heavy metal intoxication

· Depression, schizophrenia, conversion disorder

· Vasculitis, acute intermittent porphyria

13. Which of the following are melanocholic symptoms of depression?

a. Depression regularly worse in the evening.

b. Significant weight gain

c. Excessive guilt

d. lack of reactivity to usually pleasurable stimuli

e. Easy fatiguability

Ans: a. Depression regularly worse in the evening c. Excessive guilt d. lack of reactivity to usually pleasurable stimuli

Criteria for Melancholic Features Specifier

Specify if: With melancholic features (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or bipolar II disorder only if it is the most recent type of mood episode) Either of the following, occurring during the most severe period of the current episode: loss of pleasure in all, or almost all, activities lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens) Three (or more) of the following: distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one) depression regularly worse in the morning early morning awakening (at least 2 hours before usual time of awakening) marked psychomotor retardation or agitation significant anorexia or weight loss excessive or inappropriate guilt

14. Which of the following are true about schizophrenia

a. Lifetime prevalence is about 1 percent.

b. Equally prevalent in men and women.

c. Persons who develop schizophrenia are more likely to have been born in the late spring and summer

d. Higher mortality rate from accidents & natural causes than general population.

e. The most prevalent substance use is alcohol among schizophrenic patients.

Ans a. Lifetime prevalence is about 1 percent, b. Equally prevalent in men and women. D. Higher mortality rate from accidents & natural causes than general population.

§ the lifetime prevalence of schizophrenia is about 1 percent

§ Incidence : 0.5 to 5 per 10,000

§ equally prevalent in men and women

§ Onset is earlier in men than in women.

§ Outcome for female schizophrenia patients is better than that for male.

§ Persons with schizophrenia have a higher mortality rate from accidents and natural causes than the general population

§ Persons who develop schizophrenia are more likely to have been born in the winter and early spring and less likely to have been born in late spring and summer.

§ Gestational and birth complications, exposure to influenza epidemics, or maternal starvation during pregnancy, Rhesus factor incompatibility, and an excess of winter births have being implicated in the etiology of schizophrenia

§ Up to 90 percent of schizophrenic patients may be dependent on nicotine. Nicotine administration appears to improve some cognitive impairments and Parkinsonism in schizophrenia, possibly because of nicotine-dependent activation of dopamine neurons.

§ Twice as high in cities as in rural communities.

15. Which of the following are medical complications of anorexia nervosa

a. Menorrhagia

b. Hypermagnesia

c. Hypokalemia

d. Osteoporosis

e. Seizures

Ans. C. hypokalemia d. Osteoporosis e. Seizures

Medical Complications of Eating Disorders

Related to weight loss Cachexia: Loss of fat, muscle mass, reduced thyroid metabolism (low T3 syndrome), cold intolerance, and difficulty in maintaining core body temperature Cardiac: Loss of cardiac muscle; small heart; cardiac arrhythmias, including atrial and ventricular premature contractions, prolonged His bundle transmission (prolonged QT interval), bradycardia, ventricular tachycardia; sudden death Digestive-gastrointestinal: Delayed gastric emptying, bloating, constipation, abdominal pain Reproductive: Amenorrhea, low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) Dermatological: Lanugo (fine baby-like hair over body), edema Hematological: Leukopenia Neuropsychiatric: Abnormal taste sensation (?zinc deficiency), apathetic depression, mild cognitive disorder Skeletal: Osteoporosis Related to purging (vomiting and laxative abuse) Metabolic: Electrolyte abnormalities, particularly hypokalemic, hypochloremic alkalosis; hypomagnesemia Digestive-gastrointestinal: Salivary gland and pancreatic inflammation and enlargement with increase in serum amylase, esophageal and gastric erosion, dysfunctional bowel with haustral dilation Dental: Erosion of dental enamel, particularly of front teeth, with corresponding decay Neuropsychiatric: Seizures (related to large fluid shifts and electrolyte disturbances), mild neuropathies, fatigue and weakness, mild cognitive disorder