Mount Kenya University · School of Medicine · Psychiatry
Paper details
- Paper: 4th Year CATs, June 2023, Mount Kenya University Psychiatry. 30 multiple choice questions with five options each.
- Sitting: June 2023 (the day is not printed). By the timetable June falls in Trimester 3 (May to August).
- What this page has: 29 of the 30 MCQs. Question 28 (the Doppelganger phenomenon) is left out, because two of its options are false and no single answer is safe.
- Topics tested: features of schizophrenia and its negative symptoms, brief psychotic disorder, postpartum psychosis, potency and absorption of drugs, delirium and dementia, reliability, trichotillomania, fetishistic transvestism, endocrine abnormalities in mood disorders, outcome in schizophrenia, bulimia nervosa, naloxone, subarachnoid haemorrhage, Phineas Gage, Cotard syndrome and overvalued ideas.
- Repeats: several questions are the same as in the 6th Year June 2023 CAT. They were kept, because the unit repeats questions.
- Note: the scan is a student's marked paper. The handwritten marks were ignored.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q2, Q13, Q16, Q17 and Q22 are loosely worded or have more than one defensible option. The explanation says which option is best and why.
Multiple choice questions
1. Which one of the symptoms is NOT typical of schizophrenia?
- A. Thought alienation
- B. Paranoid delusions
- C. Disorientation
- D. Hallucination
- E. Disorganised speech
2. A patient presents with acute symptoms of bizarre behaviour, delusions, hallucinations and disorganised speech. What is the most likely diagnosis?
- A. Schizophrenia
- B. Brief psychotic disorder
- C. Schizoaffective disorder
- D. Schizophreniform disorder
- E. Substance-induced psychosis
3. A 35-year-old lady reports hearing voices in her head. Which of the following differences between hallucination and pseudo-hallucination is true?
- A. In true hallucinations insight is often retained
- B. True hallucinations are often identified to be originating from self
- C. True hallucinations occur in subjective space
- D. True hallucinations are sought in other modalities by the patient
- E. True hallucinations cannot occur in two modalities simultaneously
4. A young man has recently been diagnosed with paranoid schizophrenia and asks about his symptoms. All the following are negative symptoms of schizophrenia EXCEPT:
- A. Affective flattening
- B. Avolition
- C. Anhedonia
- D. Asociality
- E. Aggressiveness
5. A 24-year-old woman who gave birth 3 days ago behaves bizarrely on the obstetrics ward, accusing staff of spying on her and harming her baby. She has not slept for 24 hours and is overactive and aggressive. All the following are risk factors for postpartum psychosis EXCEPT:
- A. Primiparity
- B. Bipolar affective disorder
- C. Obstetric complications
- D. Gender of the child
- E. Single marital status
6. Haloperidol is more potent than chlorpromazine. The potency of a therapeutic formulation refers to:
- A. Strength of binding to receptors
- B. Duration of action at receptors
- C. Size of the dose required to produce an effect
- D. Elimination half-life of a drug
- E. Proportion of available receptors occupied by a drug
7. Absorption of orally administered drugs is affected by which of the following?
- A. Intestinal transit
- B. Co-administered drugs
- C. P-glycoprotein
- D. Presence of food
- E. All of the above
8. Which of the following postpartum disorders is correctly matched with its time of onset?
- A. Postpartum blues: within a few months of delivery
- B. Postpartum depression: first week of delivery
- C. Postpartum psychosis: within 2 weeks of delivery
- D. Postpartum pituitary apoplexy: 12 months after delivery
- E. All of the above are correct
9. Two clinicians using the same checklist to aid clinical description come up with the same diagnosis. Which property of the checklist is involved in this outcome?
- A. Validity of the checklist
- B. Reliability of the checklist
- C. Sensitivity of the checklist
- D. Specificity of the checklist
- E. None of the above
10. By definition, the nature of delirium that differentiates it from dementia includes which of the following?
- A. Insidious onset
- B. Acute onset
- C. Deteriorating course
- D. Familial onset
- E. Irreversible progression
11. The best option for preventing dementia available currently is:
- A. Regular NSAIDs
- B. Vitamin E
- C. Low salt diet
- D. Early retirement
- E. None of the above
12. Dementia secondary to which of the following is NOT reversible?
- A. Nutritional deficiencies
- B. Hypothyroidism
- C. Stroke
- D. Normal pressure hydrocephalus
- E. Depression
13. A 45-year-old man develops auditory hallucinations that are initially fragmented but later turn into second-person derogatory voices. The most important aspect of personal history in this case is:
- A. Stimulant use
- B. Alcohol use
- C. Relationship difficulties
- D. Psychosexual history
- E. Employment history
14. Which clinical feature of schizophrenia adds support to a neurodevelopmental hypothesis?
- A. Age of onset
- B. Stress-induced relapses
- C. Increased incidence among migrants
- D. Association with cannabis
- E. Response to antipsychotics
15. A 32-year-old man has circumscribed areas of alopecia. He admits to recurrent pulling of his hair, especially at times of stress, and feels relief after the act. He has a normal IQ and no other stereotyped behaviour. The most appropriate diagnosis is:
- A. OCD
- B. Tourette syndrome
- C. Trichotillomania
- D. Autism
- E. Factitious disorder
16. A 20-year-old man repeatedly cross-dresses in privacy. He experiences sexual arousal during cross-dressing but has a normal sexual relationship with his girlfriend otherwise. Which is the appropriate diagnosis?
- A. Disorder of gender identity
- B. Disorder of sexual preference
- C. Disorder of sexual orientation
- D. Disorder of chromosomal sex
- E. Sexual dysfunction of arousal phase
17. A 19-year-old boy shows recent-onset avolition, flat affect and preoccupation with religion and philosophy. He preferred being solitary most of his childhood. The most probable diagnosis includes:
- A. Simple schizophrenia
- B. Paranoid schizophrenia
- C. Hebephrenic schizophrenia
- D. Residual schizophrenia
- E. Schizoaffective disorder
18. Which of the following is the endocrine abnormality most commonly seen in depression?
- A. Hypercortisolaemia
- B. Hypocortisolaemia
- C. Hypothyroidism
- D. Hypopituitarism
- E. Hypoprolactinaemia
19. Which of the following endocrine abnormalities is suspected to be associated with rapid cycling bipolar disorder?
- A. Hypercortisolaemia
- B. Hypocortisolaemia
- C. Hypothyroidism
- D. Hypopituitarism
- E. Hyperprolactinaemia
20. Which of the following is NOT a predictor of good outcome in schizophrenia?
- A. Florid positive symptoms at onset
- B. Prominent affective symptoms
- C. Acute onset
- D. Older age of onset
- E. Long first episode
21. A 17-year-old girl is admitted to a medical unit following a prolonged period of repeated bingeing and vomiting. She induces vomiting at least six times a day but does not use laxatives or diuretics. Which laboratory finding is most likely?
- A. Low urea levels
- B. High potassium levels
- C. Low bicarbonate levels
- D. Increased thyroxine levels
- E. High amylase levels
22. Naloxone can be life-saving in cases of opioid toxicity. The commonest route of administration of naloxone for this purpose is:
- A. Subcutaneous
- B. Intramuscular
- C. Transtracheal
- D. Intrathecal
- E. Intravenous
23. The volume of distribution of a drug depends on all of the following EXCEPT:
- A. Protein binding
- B. Lipid solubility
- C. Tissue binding
- D. Half-life
- E. None of the above
24. A patient with gastritis is prescribed several psychotropic medications. She wants to know which part of her body will absorb most of these orally administered drugs. The correct answer is:
- A. Oral mucosa
- B. Large intestine
- C. Oesophagus
- D. Stomach
- E. Small intestine
25. A 50-year-old woman being treated for depression presents with acute-onset, severe headache described as the worst headache of her life. She insists on switching off the lights. Her blood pressure is 150/90 mmHg, and she complains of neck stiffness. An emergency CT scan is normal. The next most appropriate step is:
- A. Change her antidepressant
- B. Obtain an MRI scan
- C. Obtain a urine drug screen
- D. Prepare for lumbar puncture
- E. Prescribe haloperidol 2.5 mg only
26. Phineas Gage is a celebrated case in neuropsychiatry. This 25-year-old railroad foreman sustained an extraordinary brain injury, after which he had a significant change in his personality, characterised by childishness, stubborn and obstinate behaviour with frequent use of profanities. Which of the following brain regions was damaged significantly?
- A. Inferior parietal cortex
- B. Superior temporal cortex
- C. Orbitofrontal cortex
- D. Hippocampus
- E. Hypothalamus
27. A 65-year-old woman believes that she is already dead. Similar delusions are reported in which of the following diseases?
- A. Schizophrenia
- B. Depressive psychosis
- C. Late-onset depression
- D. Organic disorders
- E. All of the above
29. Overvalued ideas are NOT noted in the core symptoms of which one of the following disorders?
- A. Body dysmorphic disorder
- B. Anorexia nervosa
- C. Morbid jealousy
- D. Trans-sexualism
- E. PTSD
30. Which of the following is a psychopathology of familiarity?
- A. Deja vu
- B. Confabulation
- C. Pseudologia
- D. Parapraxis
- E. Paraphasia