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Psychiatry MCQ

1.With which anticonvulsant medication are drug levels the most useful?
a. carbamazepine
b. lamotrigine
c. phenytoin
d. valproate e. vigabatrin
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2. A photograph of a cyclist's hand is shown. Left hand shows wasting of intrinsic muscles and clawing of ring and little fingers. He has normal adduction of the thumb but weakness of adduction and abduction of the remaining digits. No sensory changes. Most likely lesion is:
a. T1 nerve root lesion
b. brachial plexopathy
c. median nerve lesion
d. distal ulnar nerve lesion at the elbow
e. lesion of the deep palmar branch of the ulnar nerve.
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3. Male unable to see out of left eye day 2 after CABG. Fundoscopy described as pale disc, fundal haemorrhage, disc swollen. Cause:
a. retinal artery embolism
b. retinal vein thrombosis
c. post cerebral artery occlusion
d. ischaemic optic neuropathy
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4. Patient with wrist drop after a night of drinking. How do you exclude a radial nerve palsy?
a. loss of triceps jerk
b. inability to flex aim when prone
c. normal sensation
d. inability to extend elbow
e. adduction of the thumb
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5) What problem in a patient is haloperidol most likely to work for
a. paranoid delusions
b. aggressive behavior
c. calling out
d. wandering
e. confusion
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6. Recent widow, headache, neurology exam normal , elderly patient who has inild anaemia and anorexia, generally unwell. Next investigation:
a. CT head
b. ESR
c. Temporal artery biopsy
d. MRI
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7. A man presents with sudden left neck pain, left Horner's and right hemiparesis. The most likely cause is:
a. left internal carotid artery dissection
b. left vertebral artery dissection
c. middle cerebral artery CVA
d. posterior inferior cerebellar artery lesion.
e. demyelination
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8) A male with seizures, MRI head seen, EEG ?TLE, ?rt handed funny movements. Cause of this:
a. hippocampal cyst
b. mesial temporal sclerosis
c. left cortical (?)
d. failure of neural migration
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9) Woman with Parkinson's disease, who initially responded to Ldopa. Then had rapid dementing illness over 6 months. What is the most likely finding on biopsy?
a. hippocampal aerobodies
b. loss of neurons in globus c.
C. lewy body diseas
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10. 35 year old male found unconscious, normal fundi and pupils, extensor plantars, fever headache and neck stiffness. CT scan of brain was done. Increased intensity around circle of Willis and midbrain. Most likely diagnosis is?
a. meningitis
b. malignant meningitis
c. subarachnoid haemorrhage
d. obstructive hydrocephalus
e. brain haemorrhage.
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11. In cisplatin neuropathy what is the most likely finding on nerve conduction studies?
a. Sensory loss
b. motor loss
c. demyelination
d. mixed motor sensory neuropathy
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12. Diabetic male with peripheral vascular disease & renovascular disease now has dementia. What is the best test to elucidate the cause?
a. CT head
b. EEG
c. lumbar puncture
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13. The most likely cause of a slowly progressive spastic paraparesis in an elderly lady is
a. Cervical spondylytic myelopathy
b. Motor neurone disease
c. Syringomyelia
d. parasagittal meningioma
e. Cerebrovascular disease
f. Multiple Sclerosis
g. Thoracic disc prolapse
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14) A patient suffers from tonic-clonic and absence seizures. They are no longer able to tolerate valproate. Your next treatment:
a. Lamotrigine
b. Vigabatrin
c. Carbamazepine
d. Gabapentin
e. Ethosuximide
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15) A 32 yo male found unconscious. The CT head is shown (very grainy picture with probably blood in sub-arachnoid space). Likely diagnosis:
a. Midbrain haemorrhage
b. Sub-arachnoid haemorrhage
c. Meningitis
d. Encephalitis
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16) An adolescent with history of seizures, plucking at their clothes and not conscious during the event, and febrile seizures when a child. MRI shown with R mesial temporal sclerosis. Diagnosis:
a. Complex partial seizures with R mesial temporal sclerosis
b. Temporal lobe epilepsy with temporal lobe cyst
c. AVM of temporal lobe
d. Absence seizures
e. Juvenile myoclonic epilepsy
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17)An EEG is shown with diffuse slowing, with slow waves occurring every second. A history is given of alcohol abuse, increasing confusion and twitching. LFT's are normal. The most likely diagnosis is:
a. Hepatic encephalopathy
b. Creutzfeldt-Jakob disease
c. Epilepsy
d. Tumour
e. Subdural haematoma
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18) ) A 55 yo female presents with increasing loss of memory and abnormal movements. The next best test for diagnosis:
a. EEG
b. CT head
c. Lumbar puncture
d. ? trinucleotide repeat number
e. ? other
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19) The old question on a female presenting with seizures a few weeks postpartum. The most likely cause is:
a. Cerebral venous thrombosis
b. Meningitis
c. Amniotic fluid embolism
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20) Photograph of hands is shown. History of cycling, told that no sensory changes. ( Photo shows partial clawing L 4th and 5th fingers). Most likely lesion:
a. T1 nerve root lesion
b. Median nerve lesion
c. Lesion deep palmar branch ulnar nerve
d. Brachial plexopathy
e. Ulnar nerve lesion at elbow
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21) Patient presents with sudden onset L Horner's syndrome, R hemiparesis. ? also given that had stiff neck. Most likely diagnosis:
a. L internal carotid dissection
b. Vertebral artery dissection
c. Middle cerebral artery territory CVA
d. Posterior inferior cerebellar artery lesion
e. Brain stem glioma
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22) A 72 yo male experiences a R parietal haemorrhage causing death. The most likely finding at post-mortem is:
a. A4 Amyloid vasculopathy
b. Gliosis
c. Berry aneurysm
d. AV malformation
e. Hypertensive changes
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23) A patient in his mid-60's initially presented with bradykinesia and tremor. There was an early response to L-dopa, but there has been rapid deterioration in mental state over the subsequent 18 months. The most likely pathological diagnosis is:

a. Lewy bodies in cortex arid substantia nigra
b. Lewy bodies only in basal ganglia
c. Neurofibrillary tangles d. Binswanger's deep white matter changes
e. Amyloid changes Show Answer

24) Which of the following best describes an EEG of a patient with herpetic encephalitis:
a. Unilateral temporal spikes
b. Generalised slowing with bi-temporal spikes
c. Other lengthy options
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25) With regard to the role of Vigabatrin (Sabril) in reducing the frequency of partial seizures in patients with epilepsy it:
a. was designed to inhibit GABA re-uptake at pre-synaptic neurons
b. acts at an allosteric site to potentiate the effects of GABA
c. was synthesised as an analogue of GABA
d. irreversibly inhibits GABA transaminase
e. activates GABA-B receptors to increase Chloride conductance.
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26) Which of the following is not a feature of the dementia seen in Gerstman-Straussler-Scheinker disease ?
a. localization of the responsible gene on chromosome 20
b. spongiosis, astrocytosis and neuronal loss neuropathologically
c. characterised by cerebellar ataxia and late dementia
d. it is due to a transmissable protein with 253 amino acids
e. it is associated with anti-neuronal anitbodies (anti-Hu) Show Answer

27) Anterior ischaemic optic neuropathy:
a. Cause of blindness in temporal arteritis
b. Microemboli most common cause
c. Diabetes is greatest risk factor in < 40 years age group
d. Rarely (<5%) affects the other eye Show Answer

28) Concerning Multiple Sclerosis:
a. Prevalence  with  latitude
b. Associated with anti-GAD antibodies in 25%
c. Transmissable in primate models
d. Associated with deposition of  arnyloid protein
e. Oligoclonal bands are not found in peripheral blood
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29) Young female, 20 weeks pregnant, presents with chorea. She has a past history of nasal perforation. ANA negative. Next investigation:
a. Cerebral angiograms
c. dsDNA
e. Antiphospholipid
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30) 22 year old male presented with severe left throbbing headache with right facial weakness. There was no impaired level of consciousness and he had not had previous similar headaches. Non-contrast CT head (not shown) was normal. (no further Hx re timing given) Next Ix:
a. No further Ix
b. LP
c. Rpt CT 1/52
d. Cerebral angiogram
e. Rpt CT with contrast
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31) To Dx Huntingdon's disease using DNA use:
b. PCR
c. The size of the triplet repeat
d. Southern hybridisation
e. Identify gene specific mutation
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