Download PGI PG 2020 May Psychiatry Solved Question Paper

1.Korsakoffpsychosis?
a)Thiaminedeficiency
b)Folatedeficiency
c)Niacindeficiency
d)Niacindeficiency

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e)None
CorrectAnswer-A
Ans.is'a'i.e.,Thiaminedeficiency
Alcoholicpatientswithchronicthiaminedeficiencyalsomayhave
centralnervoussystem(CNS)manifestationsknownasWernicke's

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encephalopathy,consistingofhorizontalnystagmus,
ophthalmoplegia(duetoweaknessofoneormoreextraocular
muscles),cerebellarataxia,andmentalimpairment.
Whenthereisanadditionallossofmemoryandaconfabulatory
psychosis,thesyndromeisknownasWernicke-Korsakoff

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syndrome.Despitethetypicalclinicalpictureandhistory,Wernicke-
Korsakoffsyndromeisunderdiagnosed"(Harrison19th/96e-3,
18th/597)
ThereareSixMajorSymptomsofKorsakoff'sSyndrome:
Anterogradeamnesia:Inabilitytoformnewmemories

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Retrogradeamnesia:Severelossofmemoriesformedbeforethe
onsetofthecondition
Confabulation:Thatis,inventedmemorieswhicharethentakenas
trueduetogapsinmemorysometimesassociatedwithblackouts
Minimalcontentinconversation

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Lackofinsight
Apathy:Thepatientsloseinterestinthingsquicklyandgenerally

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appearindifferenttochange.

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2.Trueaboutsucideattemptsareallexcept?
a)Hopelessnessisoneoftheimportantpredictor

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b)Sameasparasuicide
c)Increasedriskwithsubstanceabuse
d)Commonlyseeninyoungmale
e)None
CorrectAnswer-B:D

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Ans.is'b'i.e.,sameasparasuicide&'d'i.e.,commonlyseenin
youngmale
FeelingofHopelessnessandlonelinessarepresentinmostofthe
suicideattempts.
Parasuicideisnon-suicidalselfinjury.

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Substanceabuseisariskfactorforsuicide.
Suicidalattemptsaremorecommoninfemales(suicidesaremore
commoninmales).

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3.Apatientwithparanoidschizophreniatalks
aboutcomnimicro',butheisunableto

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explainitindetailandreachaconclusion.
Heoftenrepeatslastsyllableofoneword
oflastsentence.Thiscanberelatedto-
a)Circumstantiality
b)Neologism

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c)Preservation
d)Knight'smovement
e)Logoclonia
CorrectAnswer-C:E
Ans.is'c'i.e.,Preservation&'e'i.e.,Logoclonia

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Ref:TextbookofMarketingPsychiatryp.319)
Perseveration:
Continuingwithaverbalresponsewhichwasinitiallyappropriate,
However,thereafterthereispersistentandinappropriaterepetition
ofthesameverbalresponse.Thereisoutofcontextrepetitionof

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words,phrases,ideasorpointsevenafterithasbeendealtwith
exhaustivelyorthelistenerhastriedtochangethesubject.
Perseverationaffectsspeechanditgottwoforms:
Logoclonia:
Lastsyllableofthelastwordisrepeated,eg.Iamwelltodayayay

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ayay
Palilalia:
Repeatedwordisperseveratewithincreasingfrequency.

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Thereisrepetitionofwordsandphrasesratherthansyllable.

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4.Maniadoesnotinclude?

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a)Delusionofgrandeur
b)Delusionofguilt
c)Delusionofpersecution
d)Delusionofreference
e)Delusionofinfidelity

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CorrectAnswer-B:E
Ans.is'b'i.e.,Delusionofguilt&'e'i.e.,Delusionofinfidelity
Ref:NirajAhujap.69-71;Kaplan&Saddockp.358,64-71
Symptomsofmania:
Maniaisantipodaltodepressionanditssymptomsareamirror

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imageofthoseofdepression.
Theclassicaltriadofsymptomsincludeselatedmood,pressureof
speech,andincreasedpsychomotoractivity.
ImportantsignandsYmptomsofmaniaare:-
Elevatedmood:-Euphoria(mildelevation),Elation,(moderate

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elevation),Exaltation(severeelevation),Ecstasy(Verysevere
elevation).Moodmaybecomeirritable,ifpersonisstoppedfrom
doingwhathewants.
Thought&speech:-Pressureofspeech(rapidtalk,over-talkative),
flightofideas,delusionofgrandeur.delusionofpersecution

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secondarytodelusionofgrandeur(e.g.,personthinksthatpeople
areagainstmebecauseIamsogreat),delusionofreference,
delusionoflove(erotomania),Distractibility.Thereishighself
esteem.
Increasedpsychomotoractivity:-Overactiveness,restlessness,

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increasedenergy,thereisnotimeforrest.

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5.WhichofthefollowingisNOTassociated
withantisocialpersonality?
a)Nofeelingofguilt
b)Unstableandintenseinterpersonalrelationship

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c)Nocareaboutfeelingofother
d)Recurrentsuicidalthreats
e)Disruptedselfimage
CorrectAnswer-B:D
Ans.is'b'i.e.,Unstableandintenseinterpersonalrelationship

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&'d'i.e.,Recurrentsuicidalthreats
RefNirajAhuja6th/ep.122;Essentialsofclinicalpsychiatry4th/ep.
878;Namboodiri/ep.305)
Thesetwoareassociatedwithborderlinepersonalitydisorder.
Antisocial(Dissocial)personalitydisorder:

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Theessentialfeaturesofantisocialpersonalitydisorderarea
disregardforandviolationoftherightsoftheotherandtherulesof
thesociety.
Itischaracterizedbyrepeatedviolationofthelawandrulesofthe
society:

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Patientwithantisocialpersonalitydisordermayhavecriminal
behaviour,homicide,sexualoffencesanddrugabuse.
Physicalaggressiveness
Recklessdisregardforsafetyofselforothers;Consistent
irresponsibilityinworkandfamilyenvironmentandlackofremorse.

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Thisdisorderissynonymouswithpreviouslyusedterms/like
psychopathorsociopath.

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Antisocialpersonalitydisorderimpairsaperson'sabilitytocare
aboutthefeelingsandneedsofothers.Theymaynotfeelempathy
orguild.

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6.Whichofthefollowingisnotaparaphilia?
a)Adultery
b)Masochism
c)Exhibitionism
d)Frotteurism

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e)Lesbianism
CorrectAnswer-A:E
Ans.is'a'i.e.,Adultery&'e'i.e.,Lesbianism
Ref:Parikhfi/ep.411-12;Reddy32th/ep.411;NirajAhujaVh/ep.
124;wikipedia.orgl

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Paraphilias-Olddefinition
Aparaphiliaisaconditioninwhichaperson'ssexualarousaland
gratificationdependonfantasizingaboutandengaginginsexual
behaviorthatisatypicalandextreme.
Thusallsexualpertersionsandunnaturalsexualoffences(e.g.

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homosexuality,bestialityetc.)areparaphilias.
TheDSM-5acknowledgesthatmanydozensofparaphiliasexist,but
onlyhasspecificlistingsforeightthatareforensicallyimportantand
relativelycommon.
Thesearevoyeuristicdisorder,exhibitionisticdisorder,frotteuristic

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disorder,sexualmasochismdisorder,sexual.sadismdisorder,
pedophilicdisorder,fetishisticdisorder,andtransvesticdisorder.
Homosexualbehaviorgay&lesbianismislongerconsideredas
"Paraphilias".

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7.Mostcommonpsychiatricdisorderafter

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trauma/stress?
a)Majordepression
b)Mania
c)Schizophrenia
d)PTSD

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e)Acutestressdisorder
CorrectAnswer-D:E
Ans.is'd'i.e.,PTSD&'e'i.e.,Acutestressreaction
[Ref:NirajAhujap.111-12;Kaplan&Saddockp.437-40]
Stressdisorders:

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Stressdisorderistheconditionmarkedbythedevelopmentof
symptomsafterexposuretotraumaticlifeevett.
Thepersonreactstothisexperiencewithfearandhelplessness,
persistentlyrelivestheevent,andtriestoavoidbeingremindedofit.
Stressdisordermaybe:-

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Post-traumaticstressdisorder(PTSD):-Symptomslastsformore
thanamonth,
Acutestressdisorder:-Symptomslastforlessthan4weeks

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8.Whichvitamindeficiencycausesdementia:
a)VitaminA

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b)VitaminC
c)VitaminB12
d)VitaminB1
e)Nicotinicacid
CorrectAnswer-C:D:E

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Ans.is'c'i.e.,VitaminB12,'d'i.e.,VitaminB1&'e'i.e.,Nicotinic
acid
Ref:DementiabyBrownandHillanI't/ep.57
https://;www.ncbi.nlm.nih.gov/pmc/articles/PMC3428233/
TheB-vitamins,includingvitaminsB12,B6,B1,B2,niacin(B3)and

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folate(B9),havebeenimplicatedasProtectiveriskfactorsagainst
cognitivedeclineandAlzheimer'sdisease.
OfalltheB-vitamins,vitaminB12,niacin,andthiaminehavethe
mostclearlyestablishedrelationswithdeteriorationinmentalstate"

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9.Defencemechanisminobsessive

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compulsivedisorderis/are:
a)Undoing
b)Conversion
c)Reactionformation
d)Isolationofdefect

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e)Projection
CorrectAnswer-A:C:D
Ans.is'a'i.e.,Undoing,'c'i.e.,Reactionformation&'d'i.e.,
Isolationofaffect
Ref:NirajAhujap.97,208-210;Kaplan&Sadockp.161-62

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Importantdiseasesandtheirdefencemechanisms
Obsessivecompulsivedisease:ReactionFormation.
di$tlacement,undoing.isolationofaffect.repressioninhibition.
Phobia:-Displacement,inhibition.
Conversiondisorder(Hysteria):-Conversion.

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Persecutorydelusionsandhallucinations:-Projection.
Neuroses(neuroticreaction):-Regressiontoanearlier
state,Failureofrepression

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10.Beck'scognitivetriadofdepression
includes?

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a)Self
b)Future
c)Pastexperience
d)World&environment
e)Others

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CorrectAnswer-A:B:D
Ans.is'a'i.e.,Self,'b'i.e.,Future&'d'i.e.,Worldand
environment
[Ref:Kaplan&Saddockp.355;varioussitesinternet]
Beck'scognitivetheoryofdepression(1976)

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AaronBeckstudiedpeoplesufferingfromdepressionandfoundthat
theyappraisedeventsinanegativeway.
Beckidentifiedthreemechanismsthathethoughtwereresponsible
fordepression:
Thecognitivetriad.(ofnegativeautomaticthinking)

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Negativeselfschemas
ErrorsinLogic(i.e.faultyinformationprocessing)

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11.Whichofthefollowingis/arenotside-
effectoflithium:
a)Seizure

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b)Hyporeflexia
c)Nephrogenicdiabetesinsipidus
d)Alopecia
e)Tremor
CorrectAnswer-B

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Ans.B.Hyporeflexia
Ref:SynopsisofpsychiatrybyKaplan6Sadock11th/985-88;KDT
7th/449;pharmacologybySatoskar2ith/225
Lithium:
Mildtoxicity:GIdisturbances,drowsiness,muscularweakness,

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alopecia,allergicreaction,blurredvision,glycosuria,polyuria&
weightgain.
Chronicadministration:goiterformation,hypothyroidism&ECG
changes
Embryotoxicity:Liisembryotoxic&increasestheriskofEbstein's

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anomaly
Hyper-reflexia

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12.Trueaboutschizophrenia:
a)Q-EEGfindingisoneofdiagnosticcriteriaforschizophrenia
b)Psychosurgerycanbedoneforsomeresistantcases

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c)Familyhistoryofschizophreniaispoorprognosis
d)Depressionmaybefound
e)Onsetonlyafter40yearofage
CorrectAnswer-B:C:D
Ans.B,Psychosurgerycanbedoneforsomeresistant

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casesC,Familyhistoryofschizophreniaispoorprognosis&
D,Depressionmaybefound
[Ref:Ahuja7th/54-68;SynopsisofPsychiatrybyKaplan&Sadock
11th/300-32s
Schizophrenia:

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Equallyprevalentinmales&females.
Onset-Before25yrs.Peakage-10to20yrs(males)&25to35
yrs.(Females)
EEGrecordingshowsdecreasedalphaactivity,increasedtheta&
deltaactivity.

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QuantitativeEEG(qEEG)istheanalysisofthedigitizedEEG,andin
laytermsthissometimesisalsocalled'BrainMapping'.
Psychosurgeryisnotroutinelyindicated.
Whenused,thetreatmentofchoiceislimbicleucotomyinsome
caseswithseyere&veryprominentdepression,anxietyor

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obsessionalsymptoms

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13.Defencemechanisminobsessive-
compulsivedisorder(OCD)is/are:
a)Undoing
b)Reactionformation

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c)Suppression
d)Isolationofaffect
e)Projection
CorrectAnswer-A:B:D
Ans.A,UndoingB,Reactionformation&D,Isolationofaffect

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DefenseMechanism:
SynopsisofPsychiatrybyKaplanandSadock11th/160
Displacement-Phobio(Especiallyinchildren)&OCD.
Reactionformation
Undoing

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Inhibition
Isolation
Dissociation

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14.Beck'scognitivetriadofdepression
includes:

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a)Self
b)Future
c)Pastexperience
d)Worldandenvironment
e)Others

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CorrectAnswer-A:B:D
Ans.A,SelfB,Future&D,Worldandenvironment
AaronBeckpostulatedacognitivetriadofdepression.
Consistsof,
Viewsabouttlwself-anegativeselfprecept.

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Aboutenvironment-atendencytoexperiencetheworldashostile
and.demanding.
Aboutfuture-expectationofsufferingandfailure.
Therapyconsistsofmodifyingthesedistortions.
Cognitivetriad:Beliefsaboutoneself,theworld,andthefuture.

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15.Whichisnotabrainstimulationtechnique
:
a)Electroconvulsivetherapy
b)Magneticseizuretherapy
c)Deepbrainstimulation

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d)Rapidtranscranialmagneticstimulation
e)Cognitivetherapy
CorrectAnswer-E
Ans.E.Cognitivetherapy
SynopsisofPsychiatrybyKaplonandSadockp1065-81

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BrainStimulationTechnique:
Electricalcurrentsormagneticfieldstoalterneuronalfiring.
Transcranialtechniquesinclude:
Cranialelectricalstimulation(CES)
Electroconvulsivetherapy(ECT)

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Transcranialdirectcurrentstimulation(IDCS,alsodirectcurrent
polarization)
Transcranialmagneticstimulation(TMS)
Magneticseizuretherapy(MST)
Surgicaltechniques:

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Corticalbrainstimulation(CBS).
Deepbrainstimulation(DBS)
Vagusnervestimulation(VNS).

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16.Feature(s)ofdeliriumtremensis/are:
a)Mostcommoncomplicationinalcoholwithdrawal

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b)Auditoryhallucinationmayoccur
c)Visualhallucinationmaybepresent
d)Predominantlylow-voltagefastactivityonEEG
e)Mostseverealcoholwithdrawalsyndrome
CorrectAnswer-B:C:D:E

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Ans.B,AuditoryhallucinationmayoccurC,Visualhallucination
maybepresentD,Predominantlylow-voltagefastactivityon
EEG&E,Mostseverealcoholwithdrawalsyndrome
Deliriumtremens:
Predominantlylow-voltagefastactivity.

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Mostseverealcoholwithdrawalsyndrome.
Visual(andauditory)hallucinations.
Classicsignofalcoholwithdrawalistremulousness,

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17.Personalitytypeassociatedwithcoronary
arterydisease:

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a)A
b)B
c)C
d)D
e)E

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CorrectAnswer-A
Ans.A.A
Psychosocialfactors,includingtypeApersonality,anger,hostility,
andanxiety,havebeenimplicatedinthepathogenesisof
cardiovasculardisease.

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18.Cannabisabusemaybeassociatedwith?
a)Psychosis
b)Schizophrenia
c)Anxiety
d)Flash-back

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e)OCD
CorrectAnswer-A:B:C:D
Ans.(A)Psychosis(B)Schizophrenia(C)Anxiety(D)Flash-
back
[RefKaplan&Sadock'sp.420]

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Cannabisintoxication:
Mostcommonphysicaleffectsareredeye(conjunctivalinjection)
andmildtachycardia.
Increasedappetite("themunchie")
Drymouth

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Lightheadedness
Euphoria
Senseoffloatinginair
Derealization
Depersonalization

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Synesthesia(stimulationofonesensorymodalityproduces
sensationofothermodality).

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19.Treatmentmadality(ies)usedinmania
is/are?
a)ECT

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b)Lamotrigine
c)Moodstabilizer
d)Olanzapine
e)Valproate
CorrectAnswer-A:C:D:E

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Ans.(A)ECT(C)Moodstabilizer(D)Olanzapine(E)Valproate
Treatmentofbipolardisorder:
Treatmentofacutemania:
1. Lithium
2. Valproate

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3. Carbamazepine,Oxcarbazepine
4. Atypical6typicalantipsychotics:Olanzapine,risperidone,
quetiapine,ziprasidone,aripiprazole,Haloperidol,Chlorpromazine.
5. Benzodiazepines
Treatmentofacutebipolardepression:

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1. Antidepressantswithamoodstabilizer-Lamotrigineorziprasidone.
Maintenancetreatment:
1. Lithium(drugofchoice)
2. Carbamazepine.
3. Valproate,otherdrugswhichcanbeusedaretopiramate,

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Iamotrigine,atypicalantipsychotics(aripiprazole,olanzapine,
quetiapine,risperidone,Clozapine)andGabapentin.
Treatmentofrapidcycling:

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1. Valproateisthedrugofchoice.
2. OtherdrugsusedareCarbamazrpine,Lithium,lamotrigine.

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20.Trueaboutsomatoformdisordersand
somatizationdisorder?
a)Therearephysicalsymptomswithoutphysicalbasis
b)Somatizationdisorderischaracterizedbymultiplephysical
symptoms

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c)Conversiondisorderisasomatizationdisorder
d)Hypochondriasisisasomatoformdisorder
e)TherearepainandGIsymptomsinsomatizationdisorders
CorrectAnswer-A:B:D:E
Ans.(A)Therearephysicalsymptomswithoutphysicalbasis

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(B)Somatizationdisorderischaracterizedbymultiplephysical
symptoms(D)Hypochondriasisisasomatoformdisorder
(E)TherearepainandGIsymptomsinsomatizationdisorders
ACCORDINGTODSM-TVCLASSIFICATION:
Somatoformdisordersarecharacterizedbyrepeatedpresentation

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withphysicalsymptomsbutwithoutanyphysicalbasis.
Somatoformdisordersare:-(i)Somatizationdisorder,(ii)
Conversiondisorder,(iii)Hypochondriac,(iv)Bodydysmorphic
disorderft)Somatizationpaindisorder.
Somatizationdisorder:

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Multiplerecurrentsomaticsymptomsoflongdurationcausedby
psychologicalbasisandnophysicalillness.
Diagnosticcriteria:
Fourpainsymptoms-PaininHead(headache),abdomen,back,
joint,extremities,

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chest,rectum,duringmenstruationorsexualintercourseor

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urination.
Twogastrointestinalsymptoms-Nausea,bloating,vomiting,
diarrhea.
Onesexualsymptom-Erectiledysfunction(Impotence),ejaculatory

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dysfunction.
Onepseudoneurologicalsymptom-Mainlyglove&stocking
anesthesia,Paresthesia,
SOMATICSYMPTOMS&RELATEDDISORDERS(DSM-V):
DSM-5hasreplacedsomatoformdisorders(ofDSM-IV)withsomatic

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symPtomsandrelateddisorders.
Importantdisordersinthisgroupare:-
1. Somaticsymptomdisorder(complexsomaticsymptomdisorder)
2. Illnessanxietydisorder
3. Conversiondisorder(functionalneurologicaldisorder)

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4. Factitiousdisorders
5. Otherspecifiedsomaticsymptoms&relateddisorders(e.g'
Pseudocyesis)
Note:BodydysmorphicdisorderisreplacedalongwithOCD&
relateddisorder,

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21.Legalpsychiatricconditionsis/are?
a)Mania
b)Delirium
c)OCD
d)Delusion

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e)Phobia
CorrectAnswer-A:B:C:D:E
Ans.(A)Mania(B)Delirium(C)OCD(D)Delusion(E)Phobia
Thelegalterm'mentallyillperson'asusedinMentalHealthAct
1987(ofIndia),meansapersonwhoisinneedoftreatmentby

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reasonofanymentaldisorderotherthanmentalretardation.
Psychoses
a)OrganicPsychoses
1. Dementia
2. Druginducedpsychosis:Alcohol,Heroin,Cannabis,LSD,Cocaine.

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3. Confusionalstatesandpsychosisfollowingepilepsy,pregnancyand
childbirth,andtrauma.
4. Delirium
b)Functionalpsychoses
1. Schizophrenia

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2. Paranoidstates:Delusions
3. Affectivedisorders(Mania;depression)
B)Neuroticdisorders
1. Anxietyneurosis
2. Phobia

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3. Hysteria
4. OCD

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C)Variousorganicdisorders

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22.Feature(s)ofcatatonicschizophrenia?
a)Waxyflexibility

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b)Automaticobedience
c)Somaticpassivicity
d)Rigidity
e)Mutism
CorrectAnswer-A:B:C:D:E

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Ans.(A)Waxyflexibility(B)Automaticobedience(C)Somatic
passivicity(D)Rigidity(E)Mutism
[Ref:NeerajAhujaep.63;Essentialsofclinicalpsychiatry4th/ep.
635]
Featuresofcatatonicschizophreniamaybe:-

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l)Excitedcatatonia:
Characterizedbyincreasedpsychomotoractivity,i.e.restlessness,
agitation,excitement,aggressiveness,violence.Theimpulsive
activityoccursinresponsetohallucinationsanddelusions.
2)Stuporous(retartedcatatonia):

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Characterizedbyextremeretardationofpsychomotoractivity.It
includesmutism,rigidity,negativism,posturing,stupor,echolalia,
echopraxia,catalepsy(waxyflexibility),ambitendency,gegenhalten,
stereotypes,stupor,mannerism,Grimacing,automaticobedience.

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23.TrueaboutAlzheimer'sdisease?

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a)Earlyinvolvementofshorttermmemory
b)Lateinvolvementoflongtermmemory
c)Agnosia
d)Cloudingofconsciousness
e)Depression

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CorrectAnswer-A:B:C:E
Ans.(A)Earlyinvolvementofshorttermmemory(B)Late
involvementoflongtermmemory(C)Agnosia(E)Depression
[Ref:Kaplan6Saddock's10'h/ep.331]
Alzheimer'sdiseaseusuallypresentsin5thor6thdecade.

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Graduallyprogressivedisease.
Features:
Memoryimpairment:
1. Gradualdevelopmentofforgetfulnessisthemajorsymptom.
2. Initiallyshorttermmemory(memoryforrecenteventsandlearning

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newinformation)isinvolved.
3. Longtermmemoryisinvolvedlate.
4. Episodictypedeclarativememoryisaffectedmostly.
5. Noimpairmentinconsciousness.
Associateddisturbance-

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Disorientation,aphasia,apraxia,agnosia(anosognosia,
prosopagnosia)acalculia,lexicalanomia,judgementimPairment.
Psychiatricsymptoms:
Visualhallucination,Depressionandanxiety.

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24.Maximumscoreinminimentalstatus

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examinationis-
a)10
b)15
c)20
d)25

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e)30
CorrectAnswer-E
Ans.E.30
[Ref:KaplanandSadockp.2537]
Themini-mentalstatusexaminationoffersaquickandsimplewayto

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quantifycognitivefunctionandsteenforcognitiveImpairment.
Ithelpstoconfirmthepresenceofcognitiveimpairmentandtofollow
theprogressionofdementia.
Ittestsindividual'sorientation,attention,calculation,recall,
language,andmotorskills.Eachsectionofthetestinvolvesa

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relatedseriesofquestionsorcommands.
TheindIVIdualreceivesonepointforeachcorrectanswer.The
individualcanreceiveamaximumscoreof30points,i.e.,
MMSEis30pointprogrammetoevaluatecognitivefunction.

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25.Trueaboutgeneralizedanxietydisorder?

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a)Insomnia
b)Clearhistoryofpasttraumaticevent
c)Excessiveanxietyandworry
d)Benzodiazepinesisdrugsofchoice
e)None

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CorrectAnswer-A:C:D
Ans.(A)Insomnia(C)Excessiveanxietyandworry
(D)Benzodiazepinesisdrugsofchoice
[Ref:NirajAhujap.90-91;KaplanandSadock11'h/ep.409]
Generalizedanxietydisorder:

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Characterizedbyexcessiveanxietyandworrywhicharepersistent
&generalizedandnotrestrictedtoanyspecificsituationorobject.
Excessiveanxietyworryoccurforatleast6months.
Worryisdifficulttocontrolandisassociatedwithatleastthree
symptomsfromthefollowing:

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Selflessnessorfeelingkeyedup
Difficultyconcentrating
Muscletension
Easilyfatigued
Irritability

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Sleepdisturbance
Anxietyandworrycausesignificantdistressandimpairmentis
social,occupational,orotherdailyfunctioning.
Treatment:
Benzodiazepine-Drugofchoice.

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26.Essentialcriteriaformajordepressionare
allexcept-
a)Delusionofgrandeur
b)Lossofpleasure
c)Insomnia

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d)Hypersomnia
e)Anorexia
CorrectAnswer-A
Ans.A.Delusionofgrandeur
[RefNirajAhaiap.7l-72;KeplarnandSadsckp.357]

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Diagnosticcriteriaformajordepression
5ormoreofthefollowingsymptomsshouldbepresentmostofthe
dayforatleast2weeks:-
Depressedmood
Lossofinterestorpleasureinallactivities.

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Decrease/increaseappetiteorloss/gainofweight.
Insomniaorhypersomnia(Increasedordecreasedsleep).
Psychomotorretardationoragitation(decreasedorincreased
psychomotoractivity).
Fatigueorlossofenergy(weaknessorlethargy).

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Feelingsofworthlessnessorexcessiveguilt.
Diminishedconcentration
Recurrentthoughtsofdeathorrecurrentsuicidalideationorsuicidal
attempt.

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27.TruematchofEEGpatterninsleepEEG-

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a)K-complexisseeninstageIofNREMsleep
b)Wakingstateshowalphawave
c)Alpha-waveoccurinonsetofsleep
d)ThetawaveisthepredominantwaveinstageIofNREMsleep
e)StageIII-NREMsleepshowshighamplitudeslowwaves

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CorrectAnswer-B:D:E
Ans.(B)Wakingstateshowalphawave(D)Thetawaveisthe
predominantwaveinstageIofNREMsleep(E)StageIII-NREM
sleepshowshighamplitudeslowwaves
[RefNirajAhajap.132-34;Kaplan&Sedaockp.534]

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Fullawakeandalertstate=Betarhythm
Awake,eyesclosedandmindwanderingbutwithlessattentiveness
=Alpha-rhythm
Stage1NREM=Thetarhythm
Stage2NREM=Sleepspindles,Kcomplex

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Stage3&4NREM(Deepsleep)=Deltarhythm
REMsleep=Betarhythmandsometimesalsoreappearanceof
alpharhythm-.

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28.Naltrexoneis/areusedfor-
a)Alcoholdependence

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b)Opioiddependence
c)Cocainedependence
d)Cannabistoxicity
e)None
CorrectAnswer-A:B:C

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Ans.(A)Alcoholdependence(B)Opioiddependence
(C)Cocainedependence
[Ref:Katzungp.56-t;NiruiAhuia7h/ep.42,44,132;Pharmacology
bySatoskarp.165]
Naltrexone:

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Antagonistonallopioidreceptors)
Morepotentthannaloxone.
Givenorally.
Usedasamaintenancedrugforopioidaddicts-opioidblockade
therapyofpostaddict.

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Usedtodecreasecravinginchronicalcoholism.

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29.Whichofthefollowingis/arefeature(s)of
nicotinewithdrawal-
a)Weightloss
b)Irritability

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c)Impairedconcentration
d)Anxiety
e)Insomnia
CorrectAnswer-B:C:D:E
Ans.(B)Irritability(C)Impairedconcentration(D)Anxiety

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(E)Insomnia
Diagnosticcriteria{iaofnicotinewithdrawal:
Fourormoreofthefollowingsignsshouldbetherewithin24hours
ofwithdrawal
Dysphoriaordepressedmood

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Anxiety
Decreasedheartrate(bradycardia)
Insomnia
Difficultyconcentrating
IncreasedaPPetiteorweightgain

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Irritability,frustrationoranger
Restlessness.

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30.Neologismischaracteristicof:
a)OCD
b)Mania

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c)Bipolardisorder
d)Schizophrenia
e)Autism
CorrectAnswer-D
Ans.D.Schizophrenia

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Neologisms:
Referstoanewwordorcondensedcombinationofseveralwords
thatisnotatrueword&isnotreadilyunderstandable,although
sometimestheintendedmeaningorpartialmeaningmaybe
apparent.

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Featureofschizophrenia(thought&speechdisorder)

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31.Goodprognosisinschizophreniais/are
seenin:
a)Negativesymptoms
b)Earlyonset

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c)Acuteonset
d)Familyhistoryofschizophrenia
e)Insidiousonset
CorrectAnswer-C
Ans.C.Acuteonset

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[RefNeerajAhuja7th/62;Kaplan&SadockSynopsisofpsychiatry
1|th/318]
GoodPrognosisinSchizophrenia:
Lateonset(Onset>35yr)
Shortduration(<6months)

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Obviousprecipitatingfactors
Acuteonset/Abruptonset
Goodpremorbidsocial,sexuaIandworkhistories
Mooddisordersymptoms
(especiallydepressivedisorders)

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Married
Familyhistoryofmooddisorders
Goodsocialsupportsystems
Positivesymptoms:
Presenceofprecipitatingstressor

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Catatonicsubtype(paranoid-intermediateprognosis)
Firstepisode

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Pyknic(fat)body
Femalesex
Presenceofconfusion,perplexityordisorientationintheacute

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phase
NormalcranialCT
Outpatienttreatment-Propertreatment&goodresponseto
treatment

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32.TrueaboutAlprazolam:

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a)Antidepressant
b)Antipsychotic
c)Anti-anxiety
d)Hypnotic
e)Benzodiazepine

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CorrectAnswer-C:D:E
Ans.(C)Anti-anxiety(D)Hypnotic(E)Benzodiazepine
[RefNeerajAhuja7th/ljL;KDT7th/465;Kaplan&Sailock\Synopsis
ofPsychiatryI1th/949]
Alprazolam:

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AntianxietyDrug
Hypnotic
Anticonvulsant

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33.Feature(s)ofDelusion:
a)Shakeable

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b)Truebelief
c)Falsebelief
d)Bizarre
e)Non-bizarre
CorrectAnswer-C:D:E

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Ans.(C)Falsebelief(D)Bizarre(E)Non-bizarre
[Ref'NeerajAhuja7th/83-84;Kaplan&Sadock\Synopsisof
Psychiatry1lth/202,330-351]
Delusion:
Falseunbelievablebeliefs(falsefixedbeliefsnotinkeepingwiththe

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culture).
DiagnosisofdelusionaldisorderismadewhenapersonexhibitNon
Bizarredelusionsofatleast1monthdurationthatcannotbe
attributedtootherpsychiatricdisorders.

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34.Exposure&responseprevention

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techniqueis/areusedin:
a)Schizophrenia
b)OCD
c)Phobia
d)Mania

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e)Depression
CorrectAnswer-B:C
Ans.(B)OCD(C)Phobia
[RefAhuja7th/94,214-15,80;Kaplan&Sadockltth/42s,1266-67]
InOCD:

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TheprincipalbehavioralapproachesinOCDareexposureand
responseprevention.Desensitization,thoughtstopping,flooding,
implosiontherapy,andaversiveconditioninghavealsobeenusedin
patientswithOCD.
Inbehaviortherapy,patientsmustbetrulycommittedto

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improvement.
InPhobia:
Ifproperlyplanned,behaviortherapy(flooding,systematic
desensitization;exposure&responseprevention(relaxation
technique)isusuallysuccessful.

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35.Mostcommondisorder(s)aftertraumais:
a)Majordepression
b)Mania
c)Schizophrenia
d)PTSD

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e)Acutestressreaction
CorrectAnswer-D:E
Ans.(D)PTSD(E)Acutestressreaction
[Ref:Ahuja7th/111-12;Kaplan6Sadock11th/437-40,449]
Posttraumaticstressdisorder(PTSD):

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Startsasadelayed&protractedresponsetoanexceptionally
stressfulorcatastrophiclifeeventorsituation,whichislikelyto
causepervasivedistressinalmostanyperson(e.gdisasters,war,
rapeortorture,seriousaccident.
Symptomsmaydevelop,afteraperiodoflatency,withinsixmonths

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afterthestressormaybedelayedbeyondthisperiod.
Acutestressreaction:
Immediate&cleartemporalrelationshipb/wanexceptionalstressor
(suchasdeathofalovedone,naturalcatastrophe,accident,rape)&
theonsetofsymptoms.

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Symptomsrangefromadazedcondition,anxiety,depression,
anger,despair,overactivityorwithdrawalconstrictionoffieldof
consciousness.
Resolverapidly(withinafewhoursusually),ifremovalfromthe
stressfulenvironmentispossible.

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Ifstresscontinuesorcannotbereversed,resolutionofsymptoms
beginafterl-2days&isusuallyminimalafterabout3days.

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36.Awomanhasmilddepressionafterfew
daysofdelivery&disappearedafter2
weekinpostpartumperiod.Itmaybedue

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to:
a)Post-partumblue
b)Mania
c)Post-partumdepression
d)Milddepression

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e)Postpartumpsychosis
CorrectAnswer-A
Ans.(A)Post-partumblue
Normallyaround25-50%ofallwomencandeveloppsychological
symptomsinthepuerperalperiod.

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Commonesttypeofpresentationismilddepression&irritability,
oftenknownaspostnatalblues.
Passoffwithinafewdays.
SeverepsychiatricsymPtomsincludeddepressiveepisodewith
psychoticsymPtoms(mostcommon),schizophrenialikesymptoms,

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manicepisode&delirium(leastcommon).

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37.Feature(s)ofSchizophreniais/are:
a)1stranksymptomishelpfulinmakingdiagnosis
b)Depressionmaybepresent
c)Brainventricleenlargementmaybepresent

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d)Onsetoccuronlyafterageof40yr
e)Usuallyonsetoccurlaterinwomenascomparedtomen
CorrectAnswer-A:B:C:E
Ans.(A)1stranksymptomishelpfulinmakingdiagnosis
(B)Depressionmaybepresent(C)Brainventricleenlargement

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maybepresent(E)Usuallyonsetoccurlaterinwomenas
comparedtomen
Schizophrenia:
Twocommonaffectivesymptom:
Reducedemotionalresponsiveness(warrantthelabelofanhedonia,

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andoverlyactiveandinappropriateemotionssuchasextremesof
rage,happiness,andanxiety).
Otherfeelingtonesincludeperplexity,asenseofisolation,
overwhelmingambivalence&depression.
Onset:

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Usuallylaterinwomen&oftenrunsamorebenigncourse.
(Comparedtomen).
CNSinvolvement:
Computedtomography(CT)scansofpatientswithschizophrenia
haveconsistentlyshownlateralandthirilventricularenlargement

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and,somereductionincorticalvolume.
Diagnosis:
Schneider'sfirstranksymptomsofschizophreniathoughnotspecific

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butofgeathelpinmakingdiagnosis&havesignificantlyinfluenced
thediagnosticcriteria&classificationofschizophrenia.

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38.Whichoffollowingisperceptiondisorder:
a)Delusion
b)Hallucination
c)Obsession
d)Depersonalization

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e)Illusion
CorrectAnswer-B:C
Ans.(B)Hallucination(C)Obsession
[RefNirajAhuja6th/14,17;Kaplan&Sailockl1th/233,281]
Perception:

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Processofbeingawareofasensoryexperience&beingableto
recognizeitbycomparingitwithpreviousexperiences.
Perceptiondisordersare-hallucinations,illusions&
misinterpretations;depersonalization/derealization;somaticpassivity
phenomenon;autoscopy;abnormalvestibularsensationsetc.

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39.Whichofthefollowingmodalityis/arenot
includedinbehaviourtherapy:
a)Roleplaying
b)Schedulingactivities
c)Gradedtaskassignment

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d)Identifyingmaladaptiveassumptions
e)None
CorrectAnswer-D
Ans.D.Identifyingmaladaptiveassumptions
[RefNkajAhuja6th/85,228-30;IGplan&Saddok:sSynopsisof

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Psychiatry10th/953-959]
BehavioralTechniques:
Thisincludesthevariousshort-termmodalitieslikesocialskills
trainingproblemsolvingtechniques,assertivenesstraining,self-
controltherapy,activityscheduling&decision-makingtechniques.

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Amongthebehavioraltechniquesincognitivetherapyare
schedulingactivities,masteryandpleasure,gradedtask
assignments,cognitiverehearsal,self-reliancetraining,role-playing,
anddiversiontechniques.

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40.Diazepamcanheusedfor:

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a)Agitationinemergencyroom
b)Longtermtreatmentofepilepsy
c)Statusepilepticus
d)Convulsionintetanus
e)None

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CorrectAnswer-A:C:D
Ans.(A)Agitationinemergencyroom(C)Statusepilepticus
(D)Convulsionintetanus
[Ref.KDT7th/a0a-05;NirajAhuja6th/209;Kaplan6Saddok!
SynopsisofPsychiatryIqth/I0I8-20]

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UsesofDiazepam:
Firstlinedrugforemergencycontrolofconvulsionse,g.,status
epilepticus,tetanus'eclampsia,convulsantdrugpoisoning.
Narcoanalysisorabreation.
Antipsychoticinducedakathisia

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Treatmentofalcoholwithdrawal&otherdrugwithdrawalsyndrome
Nightmares(diazepamalsoreducetheREMsleepduration)
Insomnia.
Stage4NREMsleepdisorderslikeenuresis,somnambulism
(diazepamreducedurationofstage4NREMsleep).

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Agitateddepression

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41.Benzodiazepinesusedinseizure
treatment:
a)Lorazepam
b)Tenezepam

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c)Alprazolam
d)Clobazam
e)Midazolam
CorrectAnswer-A:D
Ans.(A)Lorazepam(D)Clobazam

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[RefKDT7th/398]
AntiepilepticBenzodiazepines:Clonazepam,diazepam,Lorazepam
dtclobazam.
FebrileseizureOraldiazepam,midazolam&clobazamareeffective
prophylactics(Intermittent).

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42.Whichofthefollowingistrueregarding
catatonia
a)Prominentsensorysymptom
b)Prominentmotorsymptom
c)ECTisTOCforlifethreateningcatatonia

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d)MaybeassociatedwithCNSdisease
e)None
CorrectAnswer-B:C:D
Ans.B,ProminentmotorsymptomC,ECTisTOCforlife
threateningcatatonia&D,MaybeassociatedwithCNSdisease

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[Ref:Kaplan6Sadock\1lth/292,343-46,1068;Ahuja7th/57-s9,
2255th/60-61,1423;NewOxfordTextbookofPsychiatry1st/167;
Harrison19th/1771,17th/147]
Catatonia:
CatatoniawasfirstdescribedbyKahlbaum,whodescribeda

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syndromewithprominentmotor&behavioralsymptoms.
Characterizedbymotorabnormalitiessuchascatalepsy,mutism,
posturing&negativism.
Itcanbeassociatedwithanothermentaldisorder(e.g.,
schizophreniaorbipolardisorder)orduetoanothermedical

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condition(e.g.,neoplasm,headtrauma,hepaticencephalopathy
ECTisappropriateforcatatoniaduetoageneralmedicalcondition,
especiallyifthecatatoniaislifethreatening(e.g.,inabilitytoeat)or
hasdevelopedintolethal(malignant)catatonia.

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43.Allaretrueaboutnarcolepsyexcept:

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a)Daydreaming
b)Hypnagogichallucinations
c)Cataplexy
d)Suddensleep
e)DecreasedREMlatency

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CorrectAnswer-A
Ans.(A)Daydreaming
[RefNeerajAhuja7th/Ij8-39;Kaplan&SailocklsTextbookof
psychiatry11th/547-50;Harrison19th/189,t7th/172-ZB;CMDT
2016/1072]

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Narcolepsy:
Disordercharacterizedbyexcessivedaytimesleepinessoften
dkturbetlnighttimesleepanddisturbancesinREMsleep.
HallmarkofthisdisorderisdecreasedREMlatency,I.e.decreased
latentperiodbeforethefirstREMperiodoccurs.

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NormalREMlatencyis90-100minutes,innarcolepsy,REMsleep
occurswithin10minutesoftheonsetofsleep.
Classicaltetradofsymptoms:
Sleepattacks(MC)
Cataplexy

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Hallucinationsatsleeponset(Hypnagogic)anduponwaking
(Hypnopompic)
Sleepparalysis.

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44.WhichofthefollowingistrueaboutOCD:
a)Anxiety

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b)Compulsion
c)Hallucination
d)Obscession
e)Egoalien
CorrectAnswer-A:B:D:E

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Ans.A,AnxietyB,CompulsionD,Obscession&E,Egoalien
[RefAhuja7th/9s-98]
ObsessiveCompulsiveDisorder(OCD):
Representedbyadiversegroupofsymptomsthatincludeintrusive
thoughts,rituals,preoccupations,andcompulsions.

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Washeriscommonesttype
PersonswithOCDarecommonlyaffectedbyothermental
disorders.
Theobsessionsorcompulsionsaretime-consumingandinterfere
significantlywiththeperson'snormalroutine,occupational

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functioning,usualsocialactivities,orrelationships.
ApatientwithOCDmayhaveanobsession,compulsion,orboth.
Features:
EgoAlien
Isolationeffect

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Undoing.
Repetitivebehaviour.
Butisunable&resultsinirresistible.

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45.FeaturesofManiaincludes:
a)Cheerfulness

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b)Anhedonia
c)Catatonia
d)Delusionofgrandeur
e)Negativethinking
CorrectAnswer-A:D

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Ans.(A)Cheerfulness(D)Delusionofgrandeur
[Refkaplan&Sadock'sTextbookofPsychiatry11th/358,364;Ahuja
7th/69-71,12]
ManicEpisode:
Anhedonia(inabilitytoexperiencePleasure)mayoccurinboth

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schizophrenia&depression.
Elevatedmoodcanpassthrough4stages,dependingonthe
severityofmanicepisode-euphoria(mildelevation),elation
(moderateelevation),emulation(severeelevation)&ecstasy(very
severeelevation).

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Personismoretalkativethanusual.
Increasedpsychomotoractivity.
Delusions(orideas)ofgrandeur(grandiosity),withmarkedlyinflated
self-esteem.
Delusionofpersecutionmaysometimesdevelopsecondaryto

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delusionofgrandeur.

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