I85PREP
⌘ K
Examen Estatal de Psiquiatría - independent subject foundations study materials
Examen Estatal de Psiquiatría - independent subject foundations study resources

Examen Estatal de Psiquiatría - independent subject foundations practice questions

One question at a time. Build your Examen Estatal de Psiquiatría - independent subject foundations understanding.

First 50 of 190 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Psychiatric assessment, descriptive psychopathology and formulation

A 28-year-old male is brought to the Policlínico after standing rigid and motionless for four hours. On examination, he maintains uncomfortable bodily postures imposed by the examiner for prolonged periods, exhibiting waxy flexibility (flexibilidad cérea) and mutism. Which psychopathological syndrome is present?

  1. Catatonic syndrome Correct answer.
  2. Paranoid syndrome
  3. Hebephrenic syndrome
  4. Delirious syndrome

Explanation

Catatonic syndrome (síndrome catatónico) is characterized by psychomotor disturbances including stupor, catalepsy, waxy flexibility (flexibilidad cérea), mutism, negativism, and posturing. In Cuban psychiatric semiology, recognizing this motor-volitional syndrome is essential because it requires urgent evaluation for secondary medical causes or psychiatric disorders such as catatonic schizophrenia or affective psychosis.

Question 2Psychiatric assessment, descriptive psychopathology and formulation

A 34-year-old schoolteacher is convinced that when television news presenters blink rapidly, they are transmitting covert warnings specifically intended for him regarding state security surveillance. Which psychopathological disturbance of thought content is demonstrated?

  1. Delusion of reference Correct answer.
  2. Nihilistic delusion
  3. Delusion of grandeur
  4. Erotomanic delusion

Explanation

A delusion of reference (idea delirante de autorreferencia) occurs when neutral, independent external events, gestures, or media broadcasts are incorrectly interpreted as possessing direct personal significance for the patient. In Cuban psychiatric diagnostic standards, self-referential ideas are common in paranoid schizophrenia and delusional disorders.

Question 3Psychiatric assessment, descriptive psychopathology and formulation

In descriptive psychopathology, what fundamental semiological characteristic differentiates an illusion from a hallucination?

  1. An illusion requires the presence of a real external sensory stimulus, whereas a hallucination occurs without an external object Correct answer.
  2. An illusion is always accompanied by insight, whereas a hallucination is never recognized as unreal
  3. An illusion only occurs in organic brain disease, whereas hallucinations are strictly functional
  4. An illusion involves only visual modalities, whereas hallucinations are exclusively auditory

Explanation

By definition in classical semiology, an illusion (ilusión) is a distorted perception of an actual external stimulus that is present in the environment (e.g., mistaking a coat hanger in the dark for an intruder). A hallucination (alucinación) is a perception occurring in the absence of any corresponding external stimulus.

Question 4Psychiatric assessment, descriptive psychopathology and formulation

During a psychiatric evaluation, a 22-year-old patient speaks rapidly with loud volume and switches incessantly from topic to topic. The connections between sentences are dictated by rhyming words and clang associations rather than logical progression, though a tenuous thread can be followed. Which thought disorder is present?

  1. Thought blocking
  2. Flight of ideas Correct answer.
  3. Perseveration
  4. Tangentiality

Explanation

Flight of ideas (fuga de ideas) is characterized by rapid speech (logorrhea) with continuous acceleration of thought flow and shifting between topics based on superficial associations, puns, or sound similarities (clang associations). It is a cardinal semiological sign of manic excitement in Cuban and international psychopathology.

Question 5Psychiatric assessment, descriptive psychopathology and formulation

A 67-year-old male who suffered a closed cranial trauma two weeks ago can recall his childhood, marriage, and work life accurately, but cannot retain new memories formed after the moment of impact. Which type of memory impairment is this patient exhibiting?

  1. Retrograde amnesia
  2. Anterograde amnesia Correct answer.
  3. Lacunar amnesia
  4. Paramnesia

Explanation

Anterograde amnesia (amnesia anterógrada o de fijación) is the inability to form and consolidate new memories after a specific precipitating point or brain injury, while remote memories established before the injury remain relatively intact. This reflects dysfunction in medial temporal lobe and hippocampal circuitry.

Question 6Psychiatric assessment, descriptive psychopathology and formulation

A 58-year-old female with profound depression insists that her gastrointestinal tract has completely disintegrated, her blood has turned to dust, and she is a walking corpse without a soul. Which classical psychopathological syndrome is illustrated?

  1. Cotard syndrome Correct answer.
  2. Capgras syndrome
  3. Fregoli syndrome
  4. Ekbom syndrome

Explanation

Cotard syndrome (delirio nihilista o de negación de órganos) is characterized by severe nihilistic delusions involving the negation of bodily organs, life, or existence, typically seen in severe melancholic depression or organic psychotic disorders. Recognition of this syndrome mandates urgent hospitalization due to extreme self-neglect and suicide risk.

Question 7Psychiatric assessment, descriptive psychopathology and formulation

A 52-year-old male with chronic alcohol use disorder provides detailed, lively accounts of sailing a fishing vessel in Havana harbor yesterday, despite having been admitted to the medical ward for the past five days. He demonstrates no intent to deceive. What semiological sign is this?

  1. Confabulation Correct answer.
  2. Pseudologia fantastica
  3. Cryptomnesia
  4. Delusional retrospective falsification

Explanation

Confabulation (confabulación) is the production of fabricated, distorted, or misinterpreted memories about oneself or the world without the conscious intention to deceive, typically filling in gaps created by severe anterograde memory deficits. It is a core feature of Korsakoff amnestic syndrome in chronic alcohol misuse.

Question 8Psychiatric assessment, descriptive psychopathology and formulation

A 29-year-old patient reports that familiar streets, trees, and buildings appear lifeless, artificial, and flat, as if he is living in a painted movie set, although he recognizes that they are physically real. Which psychopathological disturbance is this?

  1. Depersonalization
  2. Derealization Correct answer.
  3. Autoscopy
  4. Metamorphopsia

Explanation

Derealization (desrealización) is an alteration in the perception or experience of the external world so that it seems strange, artificial, dreamlike, or lacking in emotional vitality, while reality testing remains intact. Depersonalization refers specifically to feelings of detachment or estrangement from one's own body or psychic self.

Question 9Psychiatric assessment, descriptive psychopathology and formulation

A 25-year-old man looks at a routine red traffic light and instantly arrives at the unshakeable conviction that extraterrestrial beings have selected him to lead humanity. The red light was perceived normally, but an idiosyncratic, bizarre meaning was directly attached to it. Which classical phenomenon did Kurt Schneider describe here?

  1. Delusional mood
  2. Delusional perception Correct answer.
  3. Sudden delusional idea
  4. Overvalued idea

Explanation

A delusional perception (percepción delirante) is a Schneiderian first-rank symptom consisting of a two-stage process: a normal sensory perception occurs, to which a bizarre, delusional, self-referential meaning is directly attached without comprehensible emotional or rational justification. It is considered highly pathognomonic of schizophrenia.

Question 10Psychiatric assessment, descriptive psychopathology and formulation

During an interview at the Centro Comunitario de Salud Mental, a patient involuntarily imitates every physical movement, scratch, and posture adopted by the psychiatrist. What is the clinical term for this sign?

  1. Echolalia
  2. Echopraxia Correct answer.
  3. Negativism
  4. Ambitendency

Explanation

Echopraxia (ecopraxia) is the automatic, involuntary imitation and repetition of the movements, gestures, or actions of another person. Along with echolalia (imitation of vocalizations), it represents echo-phenomena characteristic of catatonic motor disturbances and frontal lobe disinhibition.

Question 11Psychiatric assessment, descriptive psychopathology and formulation

In the mental status examination, how does Cuban psychiatric semiology distinguish affective blunting (embotamiento afectivo) from affective incongruity (incongruencia o discordancia afectiva)?

  1. Blunting represents a severe reduction in emotional reactivity and intensity, whereas incongruity represents a mismatch between affective expression and thought content Correct answer.
  2. Blunting occurs only in bipolar depression, whereas incongruity is exclusive to organic brain syndromes
  3. Blunting is a transient symptom of anxiety, whereas incongruity is a permanent feature of personality disorders
  4. Blunting is characterized by emotional lability, whereas incongruity is defined as apathy without motor signs

Explanation

In psychiatric semiology, affective blunting (embotamiento afectivo) is a quantitative reduction in the intensity and responsiveness of emotional expression (a primary negative symptom). Affective incongruity or discordance (incongruencia afectiva) is a qualitative mismatch between the expressed emotion and the ideational or situational content (e.g., laughing while describing the death of a parent).

Question 12Psychiatric assessment, descriptive psychopathology and formulation

A 36-year-old male repeats the last words of every question the examining doctor asks, echoing them repeatedly with an identical intonation. What is this sign termed?

  1. Echolalia Correct answer.
  2. Palilalia
  3. Verbigeration
  4. Logoclonia

Explanation

Echolalia (ecolalia) is the involuntary repetition of vocalizations or speech uttered by another person. It is observed in catatonia, schizophrenia, neurodevelopmental disorders, and certain dementias or transcortical sensory aphasias.

Question 13Psychiatric assessment, descriptive psychopathology and formulation

A 61-year-old woman is unable to carry out learned purposeful movements, such as pretending to comb her hair or blow out a match on command, despite possessing intact motor strength, normal sensation, and full comprehension. What clinical sign does she display?

  1. Apraxia Correct answer.
  2. Agnosia
  3. Ataxia
  4. Akathesia

Explanation

Apraxia (apraxia) is the inability to execute learned, purposeful voluntary motor acts despite preservation of the fundamental motor strength, coordination, sensation, and comprehension required to do so. It signifies cortical network disruption, typically in parietal or frontal association cortices.

Question 14Psychiatric assessment, descriptive psychopathology and formulation

Which auditory hallucinatory phenomenon is classified as a first-rank symptom (síntoma de primer orden) of Kurt Schneider in the diagnostic formulation of schizophrenia?

  1. Voices conversing with one another or discussing the patient in the third person Correct answer.
  2. Unformed whistling noises or ringing bells in one ear
  3. Hearing one's name called once upon falling asleep
  4. Auditory illusions triggered by the sound of a refrigerator hum

Explanation

Voices conversing with each other (tercera persona) or voices commenting continuously on the patient's thoughts and actions are classic Schneiderian first-rank symptoms. When present in the absence of an organic or affective syndrome, they strongly support a diagnosis of schizophrenia.

Question 15Mood syndromes, longitudinal diagnosis and recovery planning

A 44-year-old female presents with two months of persistent sad mood, total loss of pleasure (anhedonia), waking up at 4:00 AM every morning with severe morning worsening of mood, psychomotor retardation, excessive guilt, and an 8 kg weight loss. Which subtype of depression is present?

  1. Major depressive episode with melancholic features Correct answer.
  2. Atypical depression
  3. Seasonal affective disorder
  4. Premenstrual dysphoric disorder

Explanation

Melancholic depression (depresión con síntomas melancólicos / melancolía) is defined by near-total loss of pleasure or lack of reactivity to pleasurable stimuli, accompanied by terminal insomnia (early morning awakening), morning mood worsening, psychomotor retardation or agitation, marked anorexia/weight loss, and excessive or inappropriate guilt.

Question 16Mood syndromes, longitudinal diagnosis and recovery planning

A 29-year-old male is brought by family after seven days of sleeping only 90 minutes per night without fatigue. He is euphoric, speaks at an unstoppable pace, claims he was granted special diplomatic status by the United Nations, and exhausted the family savings on luxury watches. What is the diagnosis?

  1. Manic episode (Bipolar I disorder) Correct answer.
  2. Hypomanic episode (Bipolar II disorder)
  3. Cyclothymic disorder
  4. Histrionic personality decompensation

Explanation

A manic episode (episodio maníaco) requires a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity lasting at least 1 week, accompanied by grandiosity, decreased need for sleep, pressured speech, racing thoughts, and marked impairment in functioning (or psychotic features/hospitalization). This defines Bipolar I disorder.

Question 17Mood syndromes, longitudinal diagnosis and recovery planning

A 36-year-old female presents with chronic feelings of sadness, low energy, poor self-esteem, and difficulty making decisions for the past three years. She notes that she has rarely had a normal mood during this period, but has never experienced a full-blown major depressive episode or suicidality. What is the diagnosis?

  1. Dysthymia (Persistent depressive disorder) Correct answer.
  2. Bipolar II disorder
  3. Adjustment disorder with depressed mood
  4. Schizoaffective disorder, depressive type

Explanation

Dysthymia (distimia o trastorno depresivo persistente) is a chronic depressive disturbance lasting at least two years in adults (one year in adolescents) characterized by depressed mood for most of the day, along with low energy, appetite changes, sleep disturbance, low self-esteem, or hopelessness, without meeting full criteria for a major depressive episode during the initial two-year period.

Question 18Mood syndromes, longitudinal diagnosis and recovery planning

What is the critical clinical distinction between a manic episode and a hypomanic episode in psychiatric nosology?

  1. Hypomania does not cause marked social or occupational impairment, does not require hospitalization, and never exhibits psychotic features Correct answer.
  2. Hypomania requires auditory hallucinations, whereas mania is purely an affective elevation
  3. Hypomania lasts for at least two weeks, whereas mania is limited to 48 hours
  4. Hypomania only occurs in childhood, whereas mania occurs exclusively in adults

Explanation

Under both CIE-10/11 and DSM-5 criteria, hypomania is distinguished from mania by severity and duration: hypomania requires at least 4 consecutive days of elevated or irritable mood with increased energy, but does NOT cause marked social or occupational impairment, does NOT necessitate hospitalization, and CANNOT feature psychotic symptoms. The presence of psychosis, hospitalization, or marked impairment automatically elevates the episode to mania.

Question 19Mood syndromes, longitudinal diagnosis and recovery planning

A 26-year-old artist describes a two-year history of cyclical mood fluctuations: periods of increased energy, creative output, and talkativeness lasting several days, alternating with periods of fatigue, gloominess, and withdrawal. Neither the highs nor the lows have ever met criteria for a full manic or major depressive episode. What is the diagnosis?

  1. Cyclothymic disorder Correct answer.
  2. Bipolar I disorder
  3. Bipolar II disorder
  4. Major depressive disorder with psychotic features

Explanation

Cyclothymic disorder (trastorno ciclotímico) is a chronic mood disorder characterized by at least two years (one year in children/adolescents) of numerous periods with hypomanic symptoms and periods with depressive symptoms that do not meet criteria for a hypomanic episode or major depressive episode.

Question 20Psychosis, differential diagnosis and ongoing care

A 30-year-old male develops persecutory delusions, auditory hallucinations, and emotional perplexity over 48 hours following the sudden death of his brother. With supportive care and brief antipsychotic pharmacotherapy, the symptoms resolve completely within 10 days, with full restoration of premorbid functioning. What is the diagnosis?

  1. Acute and transient psychotic disorder Correct answer.
  2. Paranoid schizophrenia
  3. Residual schizophrenia
  4. Schizoaffective disorder

Explanation

Acute and transient psychotic disorder (trastorno psicótico agudo y transitorio, ATPD, or psicosis reactiva breve) is characterized by an acute onset (within 2 weeks, often within 48 hours) frequently associated with acute stress, polymorphic clinical presentation, and full recovery within 1 to 3 months without residual deficit.

Question 21Psychosis, differential diagnosis and ongoing care

A 48-year-old accountant maintains an unshakeable, systematized belief that his neighbor has been installing microphones in his apartment walls for the past four years. He exhibits no hallucinations, no thought disorganization, intact affect, and retains employment and social functioning outside of this isolated belief. What is the diagnosis?

  1. Persistent delusional disorder Correct answer.
  2. Paranoid schizophrenia
  3. Dementia with Lewy bodies
  4. Schizotypal personality disorder

Explanation

Persistent delusional disorder (trastorno de ideas delirantes persistentes / paranoia) is characterized by the presence of a single delusion or a set of related systematized delusions that are persistent (often lifelong), in the absence of prominent hallucinations, thought disorder, affective blunting, or pervasive intellectual decline.

Question 22Psychosis, differential diagnosis and ongoing care

In evaluating long-term prognostic indicators in schizophrenia according to Cuban psychiatric literature and clinical practice guidelines, which feature is associated with a MORE FAVORABLE clinical outcome?

  1. Acute onset with an identifiable precipitating psychosocial stressor Correct answer.
  2. Insidious onset with marked negative symptoms in early adolescence
  3. Prominent family history of chronic deficit schizophrenia
  4. Poor premorbid social, academic, and occupational adjustment

Explanation

Factors predictive of a more favorable prognosis in schizophrenia include: acute or abrupt onset, clear precipitating stressors, late age of onset, good premorbid adjustment, predominance of positive rather than negative symptoms, female sex, and supportive family/community environments.

Question 23Anxiety, obsessive-compulsive and trauma-related formulations

A 32-year-old female presents with eight months of chronic, excessive, and uncontrollable worry regarding her children's health, financial bills, and minor household repairs. She reports motor tension, restlessness, difficulty concentrating, muscle aches, and non-restorative sleep. What is the diagnosis?

  1. Generalized anxiety disorder Correct answer.
  2. Panic disorder
  3. Agoraphobia
  4. Obsessive-compulsive disorder

Explanation

Generalized anxiety disorder (trastorno de ansiedad generalizada) is characterized by excessive, pervasive, and difficult-to-control anxiety and worry (expectación aprensiva) about various life domains for at least six months, accompanied by at least three somatic/cognitive symptoms (restlessness, easy fatigue, impaired concentration, irritability, muscle tension, sleep disturbance).

Question 24Anxiety, obsessive-compulsive and trauma-related formulations

A 26-year-old male arrives at the emergency polyclinic with sudden onset of intense terror, chest tightness, palpitations, dyspnea, trembling, dizziness, and fear of impending death. The symptoms peaked within 10 minutes and subsided over the next half hour. Physical exam, ECG, and cardiac troponins are completely normal. What clinical event occurred?

  1. Panic attack (crisis de angustia) Correct answer.
  2. Generalized anxiety exacerbation
  3. Acute dystonic reaction
  4. Myocardial infarction

Explanation

A panic attack (crisis de pánico o crisis de angustia) is a discrete episode of intense fear or discomfort that develops abruptly, reaches a peak within minutes, and is accompanied by at least four somatic/cognitive symptoms (palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea, dizziness, chills/heat, paresthesias, derealization/depersonalization, fear of losing control, fear of dying).

Question 25Anxiety, obsessive-compulsive and trauma-related formulations

A 24-year-old medical student reports marked anxiety and autonomic arousal whenever she is required to present clinical cases in front of senior professors or eat in the hospital cafeteria, fearing she will tremble, speak awkwardly, and be scrutinized as incompetent. Outside social evaluation situations, she is asymptomatic. What is the diagnosis?

  1. Social anxiety disorder (social phobia) Correct answer.
  2. Agoraphobia
  3. Specific phobia, blood-injection-injury type
  4. Avoidant personality disorder alone

Explanation

Social anxiety disorder (fobia social o trastorno de ansiedad social) is characterized by marked, persistent fear or anxiety about social or performance situations in which the individual is exposed to potential scrutiny by others, driven by fear of negative evaluation, humiliation, or rejection.

Question 26Anxiety, obsessive-compulsive and trauma-related formulations

A 31-year-old engineer spends three hours every morning checking and re-checking door locks, gas stove valves, and electrical outlets due to recurrent, distressing thoughts that a fire will break out and kill his family. He recognizes the thoughts are unreasonable, but checking temporarily relieves his overwhelming anxiety. What is the diagnosis?

  1. Obsessive-compulsive disorder Correct answer.
  2. Paranoid schizophrenia
  3. Delusional disorder
  4. Specific phobia

Explanation

Obsessive-compulsive disorder (trastorno obsesivo-compulsivo, TOC) is characterized by obsessions (recurrent, intrusive, ego-dystonic thoughts, impulses, or images causing marked anxiety) and compulsions (repetitive behaviors or mental acts performed to prevent an anticipated dreaded event or reduce anxiety according to rigid rules).

Question 27Anxiety, obsessive-compulsive and trauma-related formulations

A 35-year-old bus driver survived a severe traffic collision three months ago in which passengers died. He now presents with recurrent intrusive flashbacks, distressing nightmares of the crash, avoidance of driving or riding vehicles, emotional detachment, and pronounced hypervigilance with exaggerated startle response. What is the diagnosis?

  1. Post-traumatic stress disorder (PTSD) Correct answer.
  2. Acute stress reaction
  3. Panic disorder
  4. Malingering

Explanation

Post-traumatic stress disorder (trastorno de estrés postraumático, TEPT) develops following exposure to a traumatic event involving actual or threatened death or serious injury, characterized by persistent symptoms lasting more than one month across four clusters: intrusion (flashbacks, nightmares), avoidance of trauma-related stimuli, negative alterations in mood/cognition, and marked hyperarousal.

Question 28Anxiety, obsessive-compulsive and trauma-related formulations

A 45-year-old male has visited multiple specialist clinics over four years, convinced he has occult pancreatic cancer despite multiple normal abdominal CT scans, MRIs, and tumor markers. He continuously checks his abdomen and interprets every normal digestive sensation as proof of terminal illness, causing severe anxiety. What is the diagnosis?

  1. Illness anxiety disorder (hypochondriasis) Correct answer.
  2. Delusional disorder, somatic type
  3. Somatic symptom disorder with predominant pain
  4. Gastrointestinal malabsorption syndrome

Explanation

Illness anxiety disorder (trastorno de ansiedad por enfermedad / hipocondría) is characterized by preoccupation with having or acquiring a serious, undiagnosed medical illness, accompanied by high anxiety about health and excessive health-related behaviors (frequent body checking, doctor shopping) despite normal medical evaluations, where actual somatic symptoms are mild or absent.

Question 29Anxiety, obsessive-compulsive and trauma-related formulations

A 28-year-old accountant goes missing following an intense fiscal audit and is discovered two weeks later in a neighboring province working as a restaurant server under a different name. He has complete amnesia for his prior identity and life history, but displays no confusion, motor deficit, or psychotic symptoms. What is the diagnosis?

  1. Dissociative fugue Correct answer.
  2. Transient global amnesia
  3. Catatonic stupor
  4. Early-onset Alzheimer disease

Explanation

Dissociative fugue (fuga disociativa) is a dissociative disorder characterized by sudden, unexpected travel away from home or customary workplace, accompanied by inability to recall some or all of one's past (dissociative amnesia) and confusion about personal identity or the assumption of a new identity, typically precipitated by severe psychological stress.

Question 30Substance-related, cognitive and liaison assessment

A 75-year-old male on postoperative day 2 following hip arthroplasty suddenly becomes restless, disoriented to time and place, and pulls at his intravenous lines. He reports seeing colorful spiders crawling on the ceiling. His attention wanders rapidly, and his level of alertness fluctuates dramatically between drowsiness and agitation. What is the diagnosis?

  1. Delirium (Acute confusional syndrome) Correct answer.
  2. Vascular dementia
  3. Late-onset schizophrenia
  4. Major depressive disorder with psychosis

Explanation

Delirium (síndrome confusional agudo) is an acute, fluctuating neuropsychiatric disturbance characterized by impaired attention, clouding of consciousness, cognitive disruption, sleep-wake cycle inversion, and perceptual abnormalities (frequently visual illusions or hallucinations), typically triggered by underlying systemic medical, surgical, or pharmacological etiologies.

Question 31Substance-related, cognitive and liaison assessment

What is the primary semiological feature that differentiates delirium from a primary neurocognitive disorder (dementia)?

  1. Acute onset and prominent fluctuation in attention and level of consciousness in delirium Correct answer.
  2. Dementia is always accompanied by high fever
  3. Delirium only affects younger individuals under age 30
  4. Dementia produces sudden visual hallucinations within 24 hours

Explanation

The core hallmark distinguishing delirium from dementia is temporal course and attentional integrity: delirium has an acute onset (hours to days) with marked fluctuation across the day and prominent impairment in attention and alertness; dementia has an insidious onset (months to years) with a stable course and alert consciousness until advanced stages.

Question 32Substance-related, cognitive and liaison assessment

In the clinical management of a hospitalized elderly patient with hyperactive delirium triggered by a severe urinary tract infection, what is the single most critical therapeutic intervention?

  1. Identifying and aggressively treating the underlying medical etiology (antibiotics for the infection) Correct answer.
  2. High-dose intravenous diazepam infusion
  3. Indefinite physical four-point leather restraints
  4. Immediate administration of high-dose anticholinergics

Explanation

The absolute cornerstone of delirium management is identifying and treating the underlying somatic etiology (in this case, targeted antibiotic therapy for the urinary tract infection, along with fluid/electrolyte correction and environmental reorientation). Pharmacological agents are secondary and reserved strictly for extreme agitation threatening patient safety.

Question 33Substance-related, cognitive and liaison assessment

A 72-year-old retired schoolteacher presents with a three-year history of insidious, progressive decline in recent memory, repeated questioning, word-finding pauses (anomia), and spatial disorientation in familiar neighborhoods. Her social graces remain preserved. Brain MRI demonstrates bilateral hippocampal and medial temporal lobe atrophy. What is the diagnosis?

  1. Major neurocognitive disorder due to Alzheimer disease Correct answer.
  2. Frontotemporal dementia
  3. Prion disease (Creutzfeldt-Jakob)
  4. Normal pressure hydrocephalus

Explanation

Alzheimer disease (enfermedad de Alzheimer) is the most common cause of dementia, characterized clinically by an insidious onset and progressive deterioration of episodic memory (encoding and recall deficits due to hippocampal degeneration), followed by aphasia, apraxia, agnosia, and executive dysfunction, with characteristic medial temporal lobe atrophy.

Question 34Substance-related, cognitive and liaison assessment

A 68-year-old male with long-standing poorly controlled hypertension and two prior strokes presents with stepwise cognitive decline, emotional incontinence (pseudobulbar affect), dysarthria, and brisk deep tendon reflexes. Brain MRI reveals multiple lacunar infarcts and confluent subcortical white matter ischemic changes. What is the diagnosis?

  1. Vascular neurocognitive disorder (vascular dementia) Correct answer.
  2. Alzheimer disease
  3. Frontotemporal lobar degeneration
  4. Huntington disease

Explanation

Vascular dementia (demencia vascular) is characterized by cognitive impairment temporally or anatomically related to cerebrovascular disease, featuring a stepwise or fluctuating deterioration, executive dysfunction exceeding pure memory impairment, focal neurological deficits, pseudobulbar affect, and neuroimaging evidence of subcortical ischemic lesions or infarcts.

Question 35Substance-related, cognitive and liaison assessment

A 56-year-old executive is brought by his spouse because of marked changes in personality over the past two years: inappropriate sexual comments to colleagues, loss of empathy, compulsive consumption of sweets (hyperorality), and profound apathy, while his memory for appointments and spatial navigation remain intact. What is the diagnosis?

  1. Behavioral variant frontotemporal dementia (bvFTD) Correct answer.
  2. Alzheimer disease
  3. Korsakoff syndrome
  4. Delusional disorder

Explanation

Behavioral variant frontotemporal dementia (demencia frontotemporal, variante conductual / enfermedad de Pick) characteristically presents in presenile adults (ages 45-65) with early behavioral disinhibition, apathy, loss of empathy/sympathy, perseverative/compulsive behaviors, and hyperorality/dietary changes, with relative sparing of episodic memory and visuospatial abilities.

Question 36Substance-related, cognitive and liaison assessment

A 71-year-old female presents with fluctuating cognitive impairment, recurrent, vivid, well-formed visual hallucinations of deceased relatives sitting in her living room, and spontaneous features of parkinsonism (cogwheel rigidity, shuffling gait) without a history of levodopa therapy. What is the diagnosis?

  1. Dementia with Lewy bodies (DLB) Correct answer.
  2. Progressive supranuclear palsy
  3. Creutzfeldt-Jakob disease
  4. Bipolar disorder with psychosis

Explanation

Dementia with Lewy bodies (demencia con cuerpos de Lewy) is defined by cognitive decline with core clinical features: (1) fluctuating cognition with pronounced variations in attention and alertness; (2) recurrent, detailed visual hallucinations; (3) spontaneous motor features of parkinsonism; and (4) REM sleep behavior disorder.

Question 37Substance-related, cognitive and liaison assessment

A 66-year-old male presents with subcortical cognitive slowing, urinary urgency and incontinence, and a magnetic, wide-based, shuffling gait as if his feet are glued to the floor. CT head reveals marked ventricular enlargement disproportionate to cortical sulcal enlargement. What is the diagnosis?

  1. Normal pressure hydrocephalus Correct answer.
  2. Multiple system atrophy
  3. Wernicke encephalopathy
  4. Alzheimer disease

Explanation

Normal pressure hydrocephalus (hidrocefalia normotensiva o síndrome de Hakim-Adams) is a potentially reversible cause of neurocognitive impairment characterized by the classic clinical triad: gait disturbance (apraxia de la marcha), urinary incontinence, and subcortical dementia ('wobbly, wet, and wacky'), with ventriculomegaly on neuroimaging.

Question 38Substance-related, cognitive and liaison assessment

A 49-year-old male presents with progressive cognitive deterioration, megalomaniacal delusions of owning the national electrical grid, pupillary light-near dissociation (Argyll Robertson pupils), and tremors of the tongue and hands. VDRL and FTA-ABS in cerebrospinal fluid are reactive. What is the diagnosis?

  1. General paresis of the insane (neurosyphilis) Correct answer.
  2. Sporadic Creutzfeldt-Jakob disease
  3. Frontotemporal dementia
  4. Wilson disease

Explanation

General paresis (parálisis general progresiva) is a chronic parenchymal neurosyphilis infection caused by Treponema pallidum. Classically presenting 10-25 years after primary infection, it manifests with the 'paretic' syndrome: personality changes, grandiosity, dementia, Argyll Robertson pupils (pupils constrict to accommodation but not to light), and positive CSF treponemal tests.

Question 39Substance-related, cognitive and liaison assessment

A 32-year-old female with Systemic Lupus Erythematosus (SLE) presents with acute onset of persecutory delusions, auditory hallucinations, confusion, and memory lapses, accompanied by an active malar rash and elevated anti-dsDNA titers. What is the clinical diagnosis?

  1. Neuropsychiatric systemic lupus erythematosus (lupus cerebritis) Correct answer.
  2. Primary paranoid schizophrenia
  3. Somatization disorder
  4. Bipolar I disorder with mania

Explanation

Neuropsychiatric SLE (lupus neuropsiquiátrico o cerebritis lúpica) encompasses neurological and psychiatric syndromes directly attributable to systemic lupus erythematosus, mediated by autoantibodies (anti-ribosomal P, anti-neuronal antibodies) and vasculopathy, requiring corticosteroid/immunosuppressive therapy alongside low-dose antipsychotics.

Question 40Substance-related, cognitive and liaison assessment

A 33-year-old male experiences recurrent brief episodes consisting of an unpleasant olfactory aura (smell of burning rubber), a rising epigastric sensation, and lip-smacking automatisms, followed by 60 seconds of unresponsiveness and postictal confusion. What is the diagnosis?

  1. Temporal lobe epilepsy (focal impaired awareness seizure) Correct answer.
  2. Absence seizures
  3. Panic attack
  4. Dissociative fugue

Explanation

Temporal lobe epilepsy (epilepsia del lóbulo temporal) characteristically produces focal seizures with autonomic, psychic, or sensory auras (olfactory/uncinate hallucinatory auras, rising epigastric sensation, déjà vu), followed by impaired awareness, orofacial/manual automatisms (lip-smacking, chewing), and postictal confusion.

Question 41Substance-related, cognitive and liaison assessment

An 80-year-old female with moderate Alzheimer disease becomes markedly more agitated, confused, disoriented, and prone to wandering exclusively in the late afternoon and early evening hours as natural daylight dims. What clinical phenomenon is this?

  1. Sundowning phenomenon (síndrome del atardecer) Correct answer.
  2. Korsakoff syndrome
  3. Capgras delusion
  4. Acute neuroleptic akathisia

Explanation

The sundowning phenomenon (síndrome del atardecer o empeoramiento vespertino) refers to neuropsychiatric worsening (agitation, confusion, restlessness, wandering, disorientation) in individuals with dementia that emerges or intensifies specifically during late afternoon, twilight, or evening, related to impaired circadian pacemaking and reduced sensory input.

Question 42Substance-related, cognitive and liaison assessment

A 46-year-old chronic heavy drinker stops drinking alcohol abruptly 24 hours prior to evaluation. He presents with coarse hand tremors, profuse diaphoresis, tachycardia (115 bpm), hypertension (160/100 mmHg), anxiety, nausea, and insomnia. What is the diagnosis?

  1. Uncomplicated alcohol withdrawal syndrome Correct answer.
  2. Delirium tremens
  3. Wernicke encephalopathy
  4. Acute alcohol intoxication

Explanation

Alcohol withdrawal syndrome (síndrome de abstinencia alcohólica no complicado) develops within 6 to 24 hours after cessation or significant reduction of prolonged, heavy alcohol intake. Cardinal features include autonomic hyperactivity (sweating, tachycardia, hypertension), tremor, insomnia, anxiety, and gastrointestinal distress, with intact sensorium and orientation.

Question 43Substance-related, cognitive and liaison assessment

On day 3 of hospitalization for a femur fracture, a 50-year-old male with undisclosed chronic alcoholism becomes severely agitated, disoriented, feverish (38.9°C), profusely sweating, and experiences terrifying visual hallucinations of swarming insects. What medical emergency has developed?

  1. Delirium tremens Correct answer.
  2. Fat embolism syndrome alone
  3. Sepsis without neurological involvement
  4. Schizophrenic excitement

Explanation

Delirium tremens is the most severe, life-threatening manifestation of alcohol withdrawal, emerging 48 to 96 hours after the last drink. It is characterized by acute delirium (profound disorientation, fluctuating sensorium), intense autonomic instability (hyperthermia, tachycardia, diaphoresis, hypertension), coarse tremors, and vivid microptic visual/tactile hallucinations (zoopsias).

Question 44Substance-related, cognitive and liaison assessment

A 52-year-old severely malnourished chronic alcoholic is brought to the emergency department presenting with acute mental confusion, truncal ataxia, and bilateral lateral gaze paralysis (sixth cranial nerve palsy) with nystagmus. What is the diagnosis?

  1. Wernicke encephalopathy Correct answer.
  2. Korsakoff syndrome
  3. Marchiafava-Bignami disease
  4. Acute cerebellar stroke

Explanation

Wernicke encephalopathy (encefalopatía de Wernicke) is an acute, life-threatening neuropsychiatric emergency caused by thiamine (vitamin B1) deficiency, classically manifesting with the clinical triad: (1) encephalopathy / acute confusion; (2) cerebellar ataxia; and (3) oculomotor abnormalities (nystagmus, bilateral abducens nerve palsy, conjugate gaze palsies).

Question 45Substance-related, cognitive and liaison assessment

A 54-year-old chronic alcoholic recovers from acute Wernicke encephalopathy, but is left with a profound inability to learn new factual information (dense anterograde amnesia), significant retrograde amnesia, and prominent confabulation, with preserved IQ and alertness. What chronic condition has supervened?

  1. Korsakoff syndrome (amnestic confabulatory syndrome) Correct answer.
  2. Pick disease
  3. Vascular dementia
  4. Transient global amnesia

Explanation

Korsakoff syndrome (síndrome de Korsakoff o síndrome amnésico) is a chronic neurological consequence of severe thiamine deficiency affecting the mammillary bodies and anterior thalamic nuclei. It is characterized by severe anterograde and retrograde amnesia and spontaneous confabulation, with relatively intact general intelligence, sensorium, and attention.

Question 46Psychotherapy models, learning processes and therapeutic communication

A 24-year-old has repeated self-cutting after feared rejection, rapidly shifting views of partners from idealised to hateful, chronic emptiness, intense anger, and impulsive spending. Which management plan is most appropriate as a core treatment?

  1. Structured psychotherapy such as dialectical behaviour therapy, with a collaborative crisis plan Correct answer.
  2. Indefinite high-dose benzodiazepines as the main intervention
  3. No treatment because personality disorders are untreatable
  4. Antipsychotic depot medication for all symptoms regardless of target symptoms

Explanation

Borderline personality disorder is treated primarily with structured psychological therapies such as DBT, mentalization-based therapy, or related approaches. Medication may target comorbidity or specific symptoms but is not the core treatment.

Question 47Psychotherapy models, learning processes and therapeutic communication

A patient with alcohol use disorder says, "I know drinking is damaging my liver, but it is the only way I sleep." Which response best reflects motivational interviewing?

  1. "You must stop drinking immediately or treatment will not continue."
  2. "It sounds as if alcohol feels useful in the short term, while another part of you is worried about the harm it is causing." Correct answer.
  3. "Your insomnia is irrelevant until you accept that you are addicted."
  4. "I will arrange admission today because ambivalence means you lack capacity."

Explanation

Motivational interviewing uses empathy, reflective listening, autonomy support, and exploration of ambivalence. It avoids confrontation, coercion, and premature advice-giving.

Question 48Psychotherapy models, learning processes and therapeutic communication

A man with schizophrenia hears a voice saying he is worthless. In CBT for psychosis, which therapist intervention is most consistent with the model?

  1. Tell him the voice is definitely unreal and ask him not to mention it again
  2. Explore triggers, meanings, evidence, coping responses, and alternative explanations collaboratively Correct answer.
  3. Interpret the voice as proof of unconscious sexual conflict before discussing coping
  4. Avoid discussing voices because attention to psychotic symptoms inevitably worsens them

Explanation

CBT for psychosis works collaboratively on appraisals, distress, coping, safety behaviours, and alternative explanations. It does not rely on blunt contradiction or avoidance of symptoms.

Question 49Psychotherapy models, learning processes and therapeutic communication

A 23-year-old woman with borderline personality disorder has recurrent self-harm after interpersonal crises. In dialectical behaviour therapy, what is usually the highest priority treatment target?

  1. Detailed exploration of childhood memories before any current risk work
  2. Medication adherence, because DBT is primarily a pharmacological adherence programme
  3. Avoiding discussion of self-harm to prevent reinforcement
  4. Life-threatening behaviours, analysed with chain analysis and linked to skills practice Correct answer.

Explanation

DBT prioritises life-threatening behaviours, then therapy-interfering behaviours and quality-of-life targets. Chain analysis and skills training connect triggers, vulnerabilities, behaviours, and alternatives.

Question 50Psychotherapy models, learning processes and therapeutic communication

In psychotherapy, a patient becomes intensely angry when the therapist is two minutes late and says, "You are just like my father, always abandoning me." What concept best describes this phenomenon?

  1. Thought blocking
  2. Negative reinforcement
  3. Akathisia
  4. Transference Correct answer.

Explanation

Transference refers to feelings, expectations, and relational patterns from earlier relationships being experienced in the therapeutic relationship. It can be clinically useful when handled thoughtfully.