Psychiatric Assessment and Diagnosis Practice Questions

Q: Memory that has persisted for a week is considered to be which type of memory?

Remote memory. In psychiatric assessment, memory is traditionally categorized based on the time interval between the event and the recall. **Explanation of the Correct Answer:** In the context of the Mental Status Examination (MSE), **Remote memory** refers to the recall of events that occurred weeks, months, or years ago. While some general psychology textbooks define remote memory as spanning years, in clinical psychiatry (as per standard references like Kaplan & Sadock), memory for events persisting for **more than 24 hours to a week** is classified as remote memory. This includes the ability to recall personal history or significant past events. **Analysis of Incorrect Options:** * **A. Recent memory:** This refers to the ability to recall events from the past few hours to the last 24 hours (e.g., "What did you have for breakfast?"). * **C. Delayed memory:** This is a subset of recent memory, typically tested by asking a patient to recall three objects after a 5-to-10-minute interval. * **D. Working memory:** This is the ability to temporarily hold and manipulate information (e.g., digit span test). It lasts only seconds. **High-Yield Clinical Pearls for NEET-PG:** * **Immediate Memory:** Recall after seconds (tested via digit span). * **Recent Memory:** Recall after minutes to 24 hours. * **Remote Memory:** Recall after days to years. * **Amnesia Patterns:** In dementia (like Alzheimer’s), **recent memory** is lost first (Ribot's Law), while **remote memory** is preserved until the advanced stages. * **Confabulation:** The fabrication of memories to fill gaps in remote memory, classically seen in **Korsakoff’s Psychosis**.

Q: A 30-year-old lady presents with complaints of hematuria. On evaluation, RBCs are found in the urine. Further enquiry reveals that she has visited multiple physicians for the same complaint and demands inpatient care. She pricks her finger and mixes blood in the urine sample. What is her diagnosis?

Factitious illness. **Explanation:** The patient is presenting with **Factitious Disorder** (formerly known as Munchausen syndrome). The hallmark of this condition is the **intentional production or feigning** of physical or psychological signs and symptoms. 1. **Why Factitious Illness is Correct:** The patient is consciously creating symptoms (pricking her finger to add blood to urine) to assume the **"sick role."** Unlike malingering, the primary motivation is internal (psychological need for attention and medical care) rather than external gain. The history of "doctor shopping" and demanding inpatient care are classic clinical features. 2. **Why Other Options are Incorrect:** * **Malingering:** While symptoms are intentionally produced, the motivation is for **secondary gain** (e.g., insurance money, avoiding work/military service, obtaining drugs). This patient seeks the "sick role" itself, not a tangible external reward. * **Dissociative Disorder:** This involves an involuntary loss of integration between memories, identity, or consciousness. Symptoms are **not** intentionally produced. * **Hypochondriasis (Illness Anxiety Disorder):** The patient has a genuine fear of having a serious disease based on misinterpretation of bodily sensations. They do **not** intentionally create or fake symptoms. **Clinical Pearls for NEET-PG:** * **Motivation:** Factitious = Internal/Sick Role; Malingering = External/Secondary Gain. * **Gridley’s Sign:** Multiple abdominal scars (from unnecessary surgeries) often seen in chronic factitious disorder. * **Management:** Avoid direct confrontation; use a non-threatening approach and psychiatric referral. * **Factitious Disorder Imposed on Another (Munchausen by Proxy):** When a caregiver (usually a mother) fakes symptoms in a child to gain attention. This is considered a form of child abuse.

Q: Sexual gratification is obtained by being beaten or tortured by a sexual partner. This paraphilia is known as:

Masochism. **Explanation:** The correct answer is **Masochism** (specifically Sexual Masochism Disorder). This paraphilia involves achieving sexual arousal and gratification through the act of being humiliated, beaten, bound, or otherwise made to suffer. The core psychological concept is the association of physical or emotional pain with sexual pleasure. **Analysis of Options:** * **A. Sadism:** This is the functional opposite of masochism. In Sexual Sadism Disorder, gratification is derived from inflicting physical or psychological suffering on another person. * **C. Transvestism:** This involves recurrent and intense sexual arousal from cross-dressing (wearing clothes of the opposite sex). It is distinct from gender dysphoria as the primary motivation is sexual excitement. * **D. Fetishism:** This involves the use of non-living objects (e.g., shoes, stockings) or a highly specific focus on non-genital body parts to achieve sexual arousal. **Clinical Pearls for NEET-PG:** * **Sadomasochism:** When an individual fluctuates between both roles (inflicting and receiving pain), it is referred to as sadomasochism. * **Diagnosis:** According to DSM-5, these are only considered "disorders" if they cause significant distress, impairment, or involve non-consenting individuals. * **Voyeurism vs. Exhibitionism:** Remember that Voyeurism is "Peeping Tom" (watching others), while Exhibitionism is "flashing" (exposing oneself to others). * **Frotteurism:** Sexual arousal from touching or rubbing against a non-consenting person in public places.

Q: A 56-year-old man is brought to the clinic by his wife due to a noted personality change over the past 3 months. During the interview, the patient answers every question with the same three words. Which symptom best describes this patient's behavior?

Perseveration. ### Explanation **Correct Option: D. Perseveration** Perseveration is a formal thought disorder characterized by the **persistent repetition of a specific response** (words, phrases, or gestures) despite the absence or cessation of the original stimulus. In this clinical scenario, the patient’s inability to shift his mental set, resulting in the same three-word answer for every question, is a classic hallmark of perseveration. It is frequently associated with organic brain syndromes, particularly **Frontal Lobe lesions** or dementias. **Why other options are incorrect:** * **A. Negative symptoms:** These are core features of schizophrenia (e.g., anhedonia, avolition, affective flattening, alogia). While "alogia" involves poverty of speech, it does not specifically describe the repetitive, "stuck" nature of the patient's responses. * **B. Disorientation:** This refers to a lack of awareness regarding time, place, or person. While a disoriented patient might give incorrect answers, they do not typically repeat the same phrase for every different query. * **C. Concrete thinking:** This is the inability to understand abstract concepts or metaphors (e.g., failing to interpret a proverb). The patient would provide literal answers rather than repetitive ones. **High-Yield Clinical Pearls for NEET-PG:** * **Perseveration vs. Palilalia:** Perseveration is repeating a response to different stimuli; **Palilalia** is the repetition of one’s own words with increasing frequency and decreasing volume (common in Parkinsonism). * **Verbigeration (Word Salad):** Senseless repetition of specific words/phrases without any stimulus (often seen in Catatonic Schizophrenia). * **Echolalia:** Meaningless repetition of another person’s spoken words (seen in Autism, Schizophrenia, and Tourette’s). * **Frontal Lobe Signs:** Personality changes combined with perseveration strongly suggest a frontal lobe pathology (e.g., Pick’s disease or tumors).

Q: A 45-year-old male is always preoccupied with the feeling of illness. What is the most likely diagnosis?

Hypochondriasis. ### Explanation **Correct Option: B. Hypochondriasis** Hypochondriasis (now classified in DSM-5 as **Illness Anxiety Disorder**) is characterized by a persistent preoccupation with the fear or idea of having a serious medical illness. This belief is based on a misinterpretation of normal bodily sensations or minor symptoms. Key features include: * The preoccupation persists despite appropriate medical evaluation and reassurance. * The focus is on the **fear of having a disease** rather than the symptoms themselves. * It must last for at least 6 months for a formal diagnosis. **Why other options are incorrect:** * **A. Somatoform disorder:** This is an umbrella term. While hypochondriasis is a type of somatoform disorder, the question asks for the most specific diagnosis. In Somatization Disorder specifically, the focus is on multiple, distressing physical symptoms rather than the fear of a specific underlying disease. * **C. Munchausen syndrome (Factitious Disorder):** Here, the patient **intentionally** produces or feigns physical or psychological symptoms to assume the "sick role" without external incentives (like money or avoiding work). In hypochondriasis, the patient truly believes they are ill. * **D. Dissociative disorder:** These involve a breakdown of memory, identity, or perception (e.g., amnesia, fugue, or dissociative motor disorders). There is no primary preoccupation with physical illness. **High-Yield Pearls for NEET-PG:** * **Hypochondriasis vs. Somatization:** Hypochondriasis = Fear of *disease*; Somatization = Distress over *symptoms*. * **Malingering:** Unlike Munchausen, symptoms are faked for **secondary gain** (e.g., disability benefits, avoiding jail). * **Treatment of choice:** Cognitive Behavioral Therapy (CBT). SSRIs are useful if there is comorbid anxiety or depression. * **Doctor Shopping:** Patients with hypochondriasis frequently visit multiple doctors due to dissatisfaction with reassurances.

Q: What is the code given to psychiatric diseases in ICD-10?

F. ### Explanation **Correct Answer: B. F** The **ICD-10 (International Classification of Diseases, 10th Revision)**, published by the World Health Organization (WHO), uses an alphanumeric coding system where each chapter is assigned a specific letter. * **Chapter V (F00–F99)** is dedicated to **Mental and Behavioral Disorders**. * This chapter categorizes psychiatric conditions into blocks, such as F10–F19 for psychoactive substance use, F20–F29 for Schizophrenia and delusional disorders, and F30–F39 for Mood (affective) disorders. --- ### Analysis of Incorrect Options: * **Option A (E):** This chapter covers **Endocrine, nutritional, and metabolic diseases** (e.g., Diabetes Mellitus, Thyroid disorders). * **Option C (P):** This chapter covers **Certain conditions originating in the perinatal period** (neonatal conditions). * **Option D (G):** This chapter covers **Diseases of the Nervous System** (e.g., Epilepsy, Parkinson’s disease, Meningitis). While related to psychiatry, organic neurological pathologies are coded under G. --- ### High-Yield Clinical Pearls for NEET-PG: 1. **ICD vs. DSM:** While the ICD-10 is the global standard for general diagnostic purposes, the **DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)**, published by the APA, is also frequently used in psychiatric research and clinical practice. 2. **ICD-11 Update:** The ICD-11 has been released and is being implemented. In ICD-11, Mental, behavioral, or neurodevelopmental disorders are now found in **Chapter 06**. 3. **Key ICD-10 Codes to Remember:** * **F20:** Schizophrenia * **F32:** Depressive Episode * **F41.1:** Generalized Anxiety Disorder * **F00:** Dementia in Alzheimer's disease

Question 1

A 20-year-old female presented with complaints of nausea, vomiting, and pain in the legs. Her physical examination and lab investigations are normal. Despite repeated assurance by her doctor, she persistently requests investigations and treatment. What would be the most probable diagnosis?

Accepted Answer

Somatoform pain disorder

Answer

Generalized anxiety disorder

Answer

Conversion disorder

Answer

Somatization disorder

Question 2

Memory that has persisted for a week is considered to be which type of memory?

Accepted Answer

Remote memory

Answer

Recent memory

Answer

Delayed memory

Answer

Working memory

Question 3

A woman is referred by her lawyer to a psychiatrist to establish the diagnosis of kleptomania after she was arrested for shoplifting. Which of the following findings does not support this diagnosis?

Accepted Answer

This is the first episode of shoplifting in her entire life.

Answer

The stolen items are not needed and have little value for her.

Answer

She has committed shoplifting multiple times without being caught.

Answer

She immediately discards the stolen items after stealing them.

Question 4

A 30-year-old lady presents with complaints of hematuria. On evaluation, RBCs are found in the urine. Further enquiry reveals that she has visited multiple physicians for the same complaint and demands inpatient care. She pricks her finger and mixes blood in the urine sample. What is her diagnosis?

Accepted Answer

Factitious illness

Answer

Malingering

Answer

Dissociative disorder

Answer

Hypochondriasis

Question 5

A 45-year-old male presents with a continuous, non-progressive headache of 7 days' duration. He is convinced he has a brain tumor, despite multiple normal investigations and consultations with neurologists. He persistently requests further tests to confirm his belief. Psychiatric evaluation suggests the condition is not explained by normal findings. What is the most probable diagnosis?

Accepted Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Somatoform pain disorder

Answer

Conversion disorder

Question 6

Sexual gratification is obtained by being beaten or tortured by a sexual partner. This paraphilia is known as:

Accepted Answer

Masochism

Answer

Sadism

Answer

Transvestism

Answer

Fetichism

Question 7

A 56-year-old man is brought to the clinic by his wife due to a noted personality change over the past 3 months. During the interview, the patient answers every question with the same three words. Which symptom best describes this patient's behavior?

Accepted Answer

Perseveration

Answer

Negative symptoms

Answer

Disorientation

Answer

Concrete thinking

Question 8

A 30-year-old man believes that aliens have put an implant in his body and he feels a pushing sensation. Which type of hallucination best suits his description?

Accepted Answer

Cenesthetic hallucination

Answer

Auditory hallucination

Answer

Gustatory hallucination

Answer

Visual hallucination

Question 9

A 45-year-old male is always preoccupied with the feeling of illness. What is the most likely diagnosis?

Accepted Answer

Hypochondriasis

Answer

Somatoform disorder

Answer

Munchausen syndrome

Answer

Dissociative disorder

Question 10

What is the code given to psychiatric diseases in ICD-10?

Accepted Answer

F

Answer

E

Answer

P

Answer

G

Psychiatric Assessment and Diagnosis — MCQs

Psychiatric Assessment and Diagnosis — MCQs

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