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UKOM Sp.KJ practice questions

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Question 1Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A 24-year-old man is started on a selective serotonin reuptake inhibitor for major depressive disorder. Which mechanism best describes the primary acute action of this drug class at the synaptic level?

  1. Direct agonism at postsynaptic 5-HT2A receptors
  2. Irreversible inhibition of monoamine oxidase type A
  3. Blockade of postsynaptic D2 dopamine receptors
  4. Blockade of presynaptic serotonin reuptake transporters, increasing synaptic serotonin Correct answer.

Explanation

SSRIs act primarily by inhibiting the serotonin transporter (SERT) on the presynaptic membrane, which reduces reuptake and raises extracellular serotonin. This is a transporter-blocking action, not receptor agonism or enzyme inhibition. The clinical antidepressant effect typically lags behind this acute biochemical change.

Question 2Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

Which neurotransmitter is the principal inhibitory transmitter in the mammalian central nervous system, acting largely through ionotropic receptors that increase chloride conductance?

  1. Glutamate
  2. Acetylcholine
  3. Gamma-aminobutyric acid (GABA) Correct answer.
  4. Dopamine

Explanation

GABA is the main inhibitory neurotransmitter of the CNS, and its GABAA receptors are ligand-gated chloride channels whose opening hyperpolarizes neurons. Glutamate is the principal excitatory transmitter. Dopamine and acetylcholine are modulatory transmitters rather than the dominant inhibitory system.

Question 3Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A patient with schizophrenia is treated with a high-potency D2 antagonist. Which brain pathway is most directly implicated in the drug-induced extrapyramidal symptoms such as rigidity and tremor?

  1. Mesocortical pathway
  2. Mesolimbic pathway
  3. Nigrostriatal pathway Correct answer.
  4. Tuberoinfundibular pathway

Explanation

The nigrostriatal pathway projects from the substantia nigra to the striatum and is part of the extrapyramidal motor system. Blockade of D2 receptors here produces parkinsonism, dystonia, and akathisia. The other pathways mediate psychosis, negative symptoms, and prolactin regulation respectively.

Question 4Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

Which enzyme is the rate-limiting step in the synthesis of catecholamines from tyrosine?

  1. Tyrosine hydroxylase Correct answer.
  2. Dopamine beta-hydroxylase
  3. Dopa decarboxylase
  4. Catechol-O-methyltransferase

Explanation

Tyrosine hydroxylase converts tyrosine to L-DOPA and is the rate-limiting enzyme of catecholamine biosynthesis. Dopa decarboxylase then forms dopamine, and dopamine beta-hydroxylase converts dopamine to norepinephrine. COMT is a catabolic enzyme rather than a synthetic one.

Question 5Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A benzodiazepine is administered for acute agitation. Its sedative and anxiolytic effects result mainly from which receptor action?

  1. Direct agonism at GABAB receptors
  2. Inhibition of the GABA transporter GAT-1
  3. Positive allosteric modulation of GABAA receptors Correct answer.
  4. Antagonism at glycine receptors

Explanation

Benzodiazepines bind a site on the GABAA receptor complex and increase the frequency of chloride channel opening in the presence of GABA, producing positive allosteric modulation. They do not act directly at GABAB receptors or block reuptake. This mechanism underlies their anxiolytic, sedative, and anticonvulsant effects.

Question 6Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

Which structure connects the two cerebral hemispheres and is the largest commissural white matter tract?

  1. Fornix
  2. Mammillothalamic tract
  3. Internal capsule
  4. Corpus callosum Correct answer.

Explanation

The corpus callosum is the major commissural bundle connecting homologous regions of the two hemispheres. The fornix and mammillothalamic tract belong to the limbic circuit, and the internal capsule carries projection fibers. Callosal lesions can produce disconnection syndromes.

Question 7Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A 30-year-old woman develops hyperthermia, muscle rigidity, and altered consciousness after starting an antipsychotic. Which pathophysiological mechanism best explains the rigidity in neuroleptic malignant syndrome?

  1. Direct toxic injury to skeletal muscle mitochondria
  2. Excess serotonergic activity at 5-HT2A receptors
  3. Central dopamine blockade leading to reduced nigrostriatal dopaminergic transmission Correct answer.
  4. Overactivity of the sympathetic nervous system alone

Explanation

Neuroleptic malignant syndrome is attributed to central D2 receptor blockade, which reduces dopaminergic transmission in the striatum and hypothalamus, producing rigidity, hyperthermia, and autonomic instability. Serotonin excess characterizes serotonin syndrome instead. The mechanism is not purely sympathetic overactivity or direct myotoxicity.

Question 8Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A researcher studies a polymorphism that alters the promoter region of a gene, changing the amount of mRNA produced without altering the protein sequence. This variant is best classified as which type of genetic variation?

  1. Missense mutation
  2. Regulatory (promoter) variant Correct answer.
  3. Nonsense mutation
  4. Frameshift mutation

Explanation

A promoter variant affects gene expression by altering transcription, changing mRNA quantity rather than the encoded amino acid sequence. Missense, nonsense, and frameshift mutations all alter the coding sequence and protein product. Regulatory variants are relevant to psychiatric pharmacogenetics and susceptibility.

Question 9Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A 45-year-old man on lithium develops coarse tremor, ataxia, and confusion during a gastroenteritis with dehydration. Which mechanism best explains this presentation?

  1. Lithium is a weak base that accumulates in acidic gastric fluid
  2. Lithium induces hepatic enzymes that produce toxic metabolites
  3. Lithium is highly protein-bound and displaced by dehydration
  4. Lithium is eliminated by the kidneys and its reabsorption increases with sodium depletion Correct answer.

Explanation

Lithium is excreted almost entirely unchanged by the kidney and is reabsorbed in the proximal tubule in parallel with sodium. Dehydration and sodium depletion increase proximal sodium and lithium reabsorption, raising serum lithium and causing toxicity. This is why volume status must be monitored closely.

Question 10Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

In the classic dopamine hypothesis of schizophrenia, which receptor subtype is most strongly implicated in mediating the antipsychotic effect of first-generation neuroleptics?

  1. D1 receptors
  2. 5-HT1A receptors
  3. Alpha-1 adrenergic receptors
  4. D2 receptors Correct answer.

Explanation

Clinical potency of first-generation antipsychotics correlates closely with their affinity for D2 receptors, supporting a central role for D2 blockade in antipsychotic efficacy. D1, 5-HT1A, and alpha-1 receptors do not show this relationship. This correlation remains a cornerstone of the dopamine hypothesis.

Question 11Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A patient sustained a lesion of the medial temporal lobe including bilateral hippocampi. Which cognitive deficit would be most expected?

  1. Inability to form new declarative memories Correct answer.
  2. Impaired comprehension of spoken language
  3. Profound loss of visual acuity
  4. Loss of procedural motor learning

Explanation

Bilateral hippocampal damage classically produces anterograde amnesia for declarative (explicit) memory while leaving procedural learning relatively preserved. Procedural memory depends more on the basal ganglia and cerebellum. Visual acuity and language comprehension depend on occipital and perisylvian regions respectively.

Question 12Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

Which statement best describes the heritability estimate of schizophrenia from family and twin studies?

  1. Heritability is negligible, with almost all risk attributable to environment
  2. Heritability estimates cannot be derived from twin studies
  3. Heritability is high, with monozygotic twin concordance substantially exceeding dizygotic concordance Correct answer.
  4. Heritability is identical in monozygotic and dizygotic twins

Explanation

Twin studies show monozygotic concordance for schizophrenia of roughly 40-50% versus about 10-15% in dizygotic twins, yielding high heritability estimates of around 80%. Concordance is not 100% in monozygotic twins, indicating environmental contributions. Heritability is a population statistic, not a fixed individual risk.

Question 13Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A patient taking an MAO inhibitor eats aged cheese rich in tyramine and develops severe hypertension. Which mechanism explains this interaction?

  1. Tyramine blocks hepatic metabolism of the MAO inhibitor, causing drug accumulation
  2. Tyramine directly stimulates nicotinic receptors at the adrenal medulla
  3. Inhibited MAO allows tyramine to displace stored catecholamines and provoke a hypertensive crisis Correct answer.
  4. Tyramine competes with the drug at the GABA receptor

Explanation

MAO normally degrades tyramine, a sympathomimetic amine. When MAO is inhibited, tyramine reaches noradrenergic nerve terminals, is taken up, and displaces vesicular catecholamines, causing a surge in blood pressure. This is the classic cheese reaction and reflects the tyramine pressor effect.

Question 14Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A 60-year-old man with depression is started on a medication that blocks muscarinic acetylcholine receptors. Which adverse effect is most consistent with this mechanism?

  1. Miosis
  2. Urinary retention Correct answer.
  3. Bradycardia
  4. Diarrhea

Explanation

Muscarinic blockade reduces parasympathetic tone in the bladder, causing urinary retention, and also produces dry mouth, constipation, and mydriasis. Diarrhea, bradycardia, and miosis reflect increased cholinergic activity rather than blockade. These anticholinergic effects are common with tricyclic antidepressants.

Question 15Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

Which brain region is the primary origin of dopaminergic projections to the prefrontal cortex, a pathway implicated in cognitive and negative symptoms of schizophrenia?

  1. Raphe nuclei
  2. Substantia nigra pars compacta
  3. Locus coeruleus
  4. Ventral tegmental area Correct answer.

Explanation

The ventral tegmental area gives rise to the mesocortical and mesolimbic dopaminergic projections, including those to the prefrontal cortex. The substantia nigra projects mainly to the striatum. The locus coeruleus is noradrenergic and the raphe nuclei are serotonergic.

Question 16Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A 55-year-old man on clozapine develops fever, confusion, and a markedly elevated creatine kinase. Which mechanism most specifically accounts for the myocarditis risk associated with this drug?

  1. IgE-mediated type I hypersensitivity reaction occurring early in treatment Correct answer.
  2. Direct coronary vasospasm from serotonin reuptake inhibition
  3. Anticholinergic excess causing tachycardia
  4. D2 receptor blockade in the basal ganglia

Explanation

Clozapine-induced myocarditis is most often an early hypersensitivity reaction, with evidence of IgE-mediated and eosinophilic inflammation occurring typically in the first weeks of treatment. It is not explained by D2 blockade or anticholinergic effects. Monitoring troponin and inflammatory markers early in treatment is recommended.

Question 17Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

Which of the following best describes the function of the hypothalamic-pituitary-adrenal axis in the pathophysiology of major depressive disorder?

  1. The axis is unrelated to mood regulation
  2. Adrenalectomy is a standard treatment for depression
  3. Reduced CRH secretion with low cortisol levels is a consistent finding
  4. Hyperactivity of the axis with impaired negative feedback and elevated cortisol is commonly observed Correct answer.

Explanation

Many patients with major depression show HPA axis hyperactivity, including elevated cortisol, increased CRH, and impaired dexamethasone suppression, suggesting reduced negative feedback. This is thought to contribute to mood and cognitive symptoms. The axis is clearly involved in stress-related mood regulation.

Question 18Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A 28-year-old woman of Han Chinese ancestry is about to start carbamazepine. Pretreatment genotyping for HLA-B*15:02 is considered. What is the purpose of this test?

  1. To detect resistance to carbamazepine in epilepsy
  2. To predict the risk of agranulocytosis from carbamazepine
  3. To identify patients at increased risk of carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis Correct answer.
  4. To determine the required dose of carbamazepine

Explanation

HLA-B*15:02 is strongly associated with carbamazepine-induced severe cutaneous adverse reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, particularly in people of East Asian ancestry. Screening allows avoidance of the drug in carriers. It does not predict agranulocytosis or determine dosing.

Question 19Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

A genetic variant reduces the function of the enzyme CYP2D6. How would this most likely affect the metabolism of a prodrug that requires CYP2D6 activation, such as codeine?

  1. No change in metabolism because CYP2D6 is not involved
  2. Increased conversion to the active metabolite and greater analgesia
  3. Reduced conversion to the active metabolite and diminished analgesia Correct answer.
  4. Enhanced renal clearance of the active metabolite

Explanation

Codeine is a prodrug that CYP2D6 converts to morphine. Poor metabolizers produce less morphine and may obtain inadequate analgesia, while ultrarapid metabolizers risk toxicity. This illustrates how pharmacogenetic variation in a metabolizing enzyme can alter both efficacy and safety.

Question 20Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, neurochemistry, psychopharmacology, genetics)

In an experimental model, a drug increases the duration of GABA-gated chloride channel opening without changing the frequency of opening. This effect is most characteristic of which class of agents?

  1. Benzodiazepines
  2. Z-drugs such as zolpidem
  3. Baclofen
  4. Barbiturates Correct answer.

Explanation

Barbiturates prolong the duration of GABAA chloride channel opening, whereas benzodiazepines and Z-drugs increase the frequency of channel opening. Baclofen is a GABAB agonist and does not act on the chloride channel. This distinction underlies the greater respiratory depressant risk of barbiturates.

Question 21Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient reports hearing voices discussing him in the third person, and he experiences them as coming from outside his head. In DSM-5-TR terminology, this symptom is best classified as which type of hallucination?

  1. Auditory hallucination Correct answer.
  2. Visual hallucination
  3. Gustatory hallucination
  4. Tactile hallucination

Explanation

Hallucinations are perception-like experiences occurring without external stimuli. Voices heard as external and discussed in the third person are classically auditory hallucinations, a hallmark of psychotic disorders.

Question 22Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

In the mental status examination, a patient's speech is described as 'flight of ideas.' This finding is most characteristic of which condition?

  1. Catatonia
  2. Mania Correct answer.
  3. Major depressive disorder
  4. Obsessive-compulsive disorder

Explanation

Flight of ideas is a rapid, pressured thought and speech pattern where ideas shift by understandable associations. It is a classic feature of manic episodes and distinguishes mania from the slowed thought of depression.

Question 23Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient's belief that external events, such as song lyrics on the radio, are specifically directed at him is best described as which phenomenon?

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

Explanation

Delusions of reference involve the conviction that neutral external events or people carry special personal significance. Song lyrics or broadcast messages perceived as personally directed are a typical example.

Question 24Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

In DSM-5-TR, a schizophrenia diagnosis requires continuous signs of disturbance persisting for at least what minimum duration, with active-phase symptoms present for a substantial portion?

  1. One month
  2. Six months Correct answer.
  3. Two weeks
  4. One year

Explanation

DSM-5-TR requires continuous signs of the disturbance for at least six months, including at least one month of active-phase symptoms. The remaining period may consist of prodromal or residual symptoms.

Question 25Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient is mute, holds odd postures, and shows waxy flexibility on examination. These motor findings are most consistent with which syndrome?

  1. Akathisia
  2. Tardive dyskinesia
  3. Neuroleptic malignant syndrome
  4. Catatonia Correct answer.

Explanation

Catatonia is characterized by psychomotor abnormalities such as stupor, mutism, posturing, and waxy flexibility. Waxy flexibility refers to resistance to repositioning that the patient then maintains.

Question 26Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

Which symptom is regarded as a first-rank (Schneiderian) symptom of schizophrenia?

  1. Poor grooming
  2. Flat affect
  3. Thought insertion Correct answer.
  4. Social withdrawal

Explanation

Schneiderian first-rank symptoms include certain delusions and hallucinations such as thought insertion, thought broadcasting, and third-person auditory hallucinations. These were proposed as especially characteristic of schizophrenia.

Question 27Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient has a persistent delusion of being loved by a person of higher status who has not reciprocated, with no other prominent psychotic symptoms. This presentation best fits which delusional disorder subtype?

  1. Persecutory type
  2. Jealous type
  3. Erotomanic type Correct answer.
  4. Somatic type

Explanation

Erotomanic delusional disorder centers on the belief that another person, often of higher status, is in love with the patient. The conviction persists despite lack of reciprocation and without prominent hallucinations.

Question 28Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

In the ICD-11 classification, which term is used for the category corresponding to what DSM-5-TR calls schizophrenia?

  1. Schizophrenia Correct answer.
  2. Split personality
  3. Manic-depressive psychosis
  4. Dementia praecox

Explanation

ICD-11 retains the term schizophrenia as a category within psychotic disorders, aligning broadly with DSM-5-TR. Older terms such as dementia praecox are historical and no longer used.

Question 29Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient's mood is persistently elevated and irritable for four days, with increased goal-directed activity and reduced need for sleep, but without marked functional impairment or hospitalization. In DSM-5-TR this is best classified as which episode?

  1. Manic episode
  2. Hypomanic episode Correct answer.
  3. Mixed features episode
  4. Major depressive episode

Explanation

A hypomanic episode requires at least four consecutive days of elevated or irritable mood with increased energy and associated symptoms, but without marked impairment or hospitalization. Mania requires at least one week or hospitalization.

Question 30Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

Which feature distinguishes bipolar I disorder from bipolar II disorder in DSM-5-TR?

  1. Presence of rapid cycling
  2. Presence of at least one manic episode Correct answer.
  3. Presence of at least one hypomanic episode
  4. Presence of psychotic symptoms

Explanation

Bipolar I disorder requires at least one manic episode, whereas bipolar II disorder requires hypomanic plus major depressive episodes and never a full manic episode. Psychosis and rapid cycling can occur in either.

Question 31Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient experiences recurrent, unexpected panic attacks and then worries persistently for two months about having another attack. In DSM-5-TR this presentation best fits which diagnosis?

  1. Specific phobia
  2. Generalized anxiety disorder
  3. Panic disorder Correct answer.
  4. Social anxiety disorder

Explanation

Panic disorder requires recurrent unexpected panic attacks followed by at least one month of persistent concern about additional attacks or maladaptive behavioral change. The unexpected nature and subsequent worry are key.

Question 32Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

In DSM-5-TR, which symptom is required for the diagnosis of a major depressive episode?

  1. Elevated mood
  2. Grandiosity
  3. Flight of ideas
  4. Depressed mood or loss of interest/pleasure Correct answer.

Explanation

A major depressive episode requires either depressed mood or markedly diminished interest or pleasure as one of its core symptoms. The remaining symptoms include changes in sleep, appetite, energy, and concentration.

Question 33Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient with a chronic psychotic illness shows reduced emotional expression, poverty of speech, and diminished motivation. These are best described as which type of symptoms?

  1. Disorganized symptoms
  2. Positive symptoms
  3. Affective symptoms
  4. Negative symptoms Correct answer.

Explanation

Negative symptoms reflect a diminution or loss of normal functions, including blunted affect, alogia, and avolition. They contrast with positive symptoms such as hallucinations and delusions.

Question 34Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient reports that his thoughts are being removed from his mind by an external force. This experience is best termed which phenomenon?

  1. Circumstantiality
  2. Thought withdrawal Correct answer.
  3. Thought blocking
  4. Thought broadcasting

Explanation

Thought withdrawal is the delusional belief that thoughts have been removed from one's mind by an external agency. It is distinct from thought broadcasting, in which thoughts are experienced as accessible to others.

Question 35Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

Which instrument is a structured diagnostic interview commonly used in research to establish DSM diagnoses?

  1. MMSE
  2. PANSS
  3. HAM-D
  4. SCID-5 Correct answer.

Explanation

The Structured Clinical Interview for DSM-5 (SCID-5) is a widely used semi-structured interview designed to establish DSM diagnoses. It guides the interviewer through modules corresponding to diagnostic categories.

Question 36Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient's speech jumps between loosely connected ideas with no understandable links, and the interviewer cannot follow the associations. This is best described as which finding?

  1. Echolalia
  2. Neologism
  3. Derailment Correct answer.
  4. Clanging

Explanation

Derailment, or loosening of associations, is a formal thought disorder in which ideas slip into unrelated topics without logical connection. It differs from sound-based associations or repetition phenomena.

Question 37Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient with schizophrenia is assessed and found to have a completely flat facial expression, no vocal inflection, and no eye contact. This cluster is best captured by which term?

  1. Asociality
  2. Avolition
  3. Blunted or flat affect Correct answer.
  4. Anhedonia

Explanation

Blunted or flat affect describes reduced emotional expressiveness in face, voice, and gesture. It is a negative symptom distinct from the subjective experience of pleasure or drive.

Question 38Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

Which principle underlies the use of a multiaxial approach in older DSM editions that was removed in DSM-5?

  1. Restricting diagnosis to psychotic disorders
  2. Replacing clinical judgment with structured interviews
  3. Requiring laboratory confirmation of every diagnosis
  4. Separating clinical disorders from personality and psychosocial factors Correct answer.

Explanation

The earlier multiaxial system separated clinical disorders, personality disorders, medical conditions, and psychosocial stressors across axes. DSM-5 removed the multiaxial system and integrated these elements into a single diagnostic listing.

Question 39Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient reports that his own thoughts are repeated aloud immediately after he thinks them. This symptom is best termed which phenomenon?

  1. Delusional perception
  2. Passivity of affect
  3. Thought echo Correct answer.
  4. Thought insertion

Explanation

Thought echo, or echo de la pensee, is the experience of hearing one's own thoughts spoken aloud or repeated immediately after thinking them. It is a self-experience disturbance associated with schizophrenia.

Question 40Psychopathology, psychiatric interviewing, and classification (including DSM/ICD)

A patient's belief that a neighbor is plotting to harm him is held despite clear contradictory evidence and is not shared by others of his culture. This belief is best classified as which type of delusion?

  1. Grandiose
  2. Persecutory Correct answer.
  3. Erotomanic
  4. Somatic

Explanation

Persecutory delusions involve the conviction of being harmed, threatened, or conspired against by others. They are held with fixed certainty despite contrary evidence and are not culturally shared.

Question 41Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

A 24-year-old man has had continuous psychotic symptoms for 7 months, including auditory hallucinations and disorganized speech, with marked decline in work and self-care. Mood symptoms have been absent throughout. Which diagnosis best fits the current DSM-5-TR criteria?

  1. Brief psychotic disorder
  2. Schizophreniform disorder
  3. Delusional disorder
  4. Schizophrenia Correct answer.

Explanation

Schizophrenia requires continuous signs of disturbance persisting at least 6 months, with at least 1 month of active-phase symptoms and functional decline. This patient exceeds 6 months of continuous illness with functional deterioration, so schizophrenia is the appropriate diagnosis.

Question 42Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

Which symptom is classified as a first-rank (Schneiderian) symptom of schizophrenia?

  1. Flat affect
  2. Anhedonia
  3. Psychomotor retardation
  4. Thought broadcasting Correct answer.

Explanation

Schneider's first-rank symptoms are a set of psychotic phenomena considered strongly suggestive of schizophrenia, and thought broadcasting is one of them. They include audible thoughts, voices arguing or commenting, thought insertion or withdrawal, and passivity experiences.

Question 43Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

A patient with schizophrenia develops a high fever, muscle rigidity, autonomic instability, and elevated creatine kinase after starting an antipsychotic. Which condition must be recognized first?

  1. Neuroleptic malignant syndrome Correct answer.
  2. Acute dystonic reaction
  3. Tardive dyskinesia
  4. Serotonin syndrome

Explanation

Neuroleptic malignant syndrome is a life-threatening reaction to dopamine antagonists characterized by hyperthermia, lead-pipe rigidity, autonomic instability, and raised creatine kinase. It requires immediate discontinuation of the antipsychotic and urgent supportive management.

Question 44Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

Which finding most strongly supports a diagnosis of catatonia in a patient with a psychotic disorder?

  1. Pressured speech with flight of ideas
  2. Perseveration on cognitive testing
  3. Waxy flexibility with mutism Correct answer.
  4. Ideas of reference toward strangers

Explanation

Catatonia is a psychomotor syndrome whose signs include stupor, mutism, negativism, posturing, and waxy flexibility. The combination of waxy flexibility and mutism is a classic presentation.

Question 45Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

According to the neurodevelopmental hypothesis of schizophrenia, which set of findings is most consistent with it?

  1. Complete remission between episodes with no cognitive impairment
  2. Illness arising solely from acute psychosocial stress in adulthood
  3. Childhood motor and cognitive deviations with reduced hippocampal volume Correct answer.
  4. Onset always in late adulthood with preserved premorbid function

Explanation

The neurodevelopmental model proposes that early brain insults and genetic factors disrupt development long before psychosis appears. Supporting evidence includes childhood neuromotor and cognitive deviations, minor physical anomalies, and structural changes such as reduced hippocampal volume.

Question 46Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

A 30-year-old woman has fixed, non-bizarre beliefs that her coworkers are conspiring to get her fired, present for 8 months. She works and functions reasonably, and no hallucinations or disorganization are evident. Which diagnosis is most appropriate?

  1. Schizophrenia
  2. Delusional disorder Correct answer.
  3. Schizoaffective disorder
  4. Schizotypal personality disorder

Explanation

Delusional disorder is defined by delusions lasting at least 1 month without prominent hallucinations, disorganization, or major functional decline; non-bizarre themes are typical. This patient's fixed, plausible conspiracy delusion with preserved functioning fits.

Question 47Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

In a patient with schizophrenia treated with olanzapine, which metabolic parameter should be monitored with particular attention because of the drug's receptor profile?

  1. Fasting glucose and lipids Correct answer.
  2. Thyroid-stimulating hormone
  3. Serum lithium level
  4. Serum amylase

Explanation

Second-generation antipsychotics, especially olanzapine and clozapine, are associated with weight gain, dyslipidemia, and hyperglycemia. Baseline and periodic monitoring of fasting glucose and lipid profiles is therefore recommended.

Question 48Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

A patient with schizophrenia on long-term haloperidol develops involuntary chewing movements and tongue protrusion. Which management step is most appropriate?

  1. Reassure that this is an expected early effect that self-resolves
  2. Increase the haloperidol dose to suppress movements
  3. Add an anticholinergic such as trihexyphenidyl
  4. Switch to a lower-potency agent or consider a VMAT2 inhibitor Correct answer.

Explanation

These movements suggest tardive dyskinesia, a late-onset complication of dopamine blockade. Management includes reducing or switching the offending antipsychotic and, when needed, using a VMAT2 inhibitor such as valbenazine or deutetrabenazine.

Question 49Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

Which statement best reflects the evidence for clozapine in treatment-resistant schizophrenia?

  1. It is superior for treatment resistance but requires monitoring for agranulocytosis Correct answer.
  2. It carries no risk of myocarditis after the first month
  3. It is less effective than other agents but has fewer side effects
  4. It should be first-line for all first-episode patients

Explanation

Clozapine is the agent with the best evidence for treatment-resistant schizophrenia, defined by inadequate response to adequate trials of other antipsychotics. Its use requires regular blood-count monitoring because of the risk of agranulocytosis.

Question 50Psychotic disorders (schizophrenia spectrum and other psychotic disorders)

A patient with schizophrenia has coexisting depressive symptoms. Which principle best guides pharmacologic management?

  1. Use a mood stabilizer as the sole agent for both conditions
  2. Assess and treat depression concurrently, considering medication interactions Correct answer.
  3. Avoid all antidepressants because they are contraindicated in schizophrenia
  4. Treat the psychosis alone and expect mood to resolve automatically

Explanation

Depressive symptoms in schizophrenia are common, worsen outcome, and warrant independent assessment and treatment. Antidepressants can be used with appropriate caution and attention to interactions and to the risk of destabilizing the psychotic illness.