Mount Kenya University · School of Medicine · Psychiatry
Paper details
- Paper: 6th 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).
- Topics tested: form and content of symptoms, delusions, hallucinations and pseudo-hallucinations, thought and speech disorder, mania, withdrawal states, neuroleptic malignant syndrome, tuberous sclerosis, acute porphyria, neuroimaging, antidepressant response, lamotrigine and lithium, postpartum disorders, violence and mental disorder, autism and ADHD.
- 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: Q6, Q9, Q14, Q20, Q23 and Q28 are loosely worded or have more than one defensible option. The explanation says which option is best and why.
Multiple choice questions
1. The concept of symptoms assessed by descriptive psychopathology has both form and content as its components. Which of the following is true?
- A. Form provides sufficient information for management
- B. Form provides sufficient information for severity
- C. Form is more important than content
- D. Form provides sufficient information for diagnosis
- E. Content is more important than form
2. Which of the following is NOT a type of paranoid delusion?
- A. 'Someone is following me.'
- B. 'People in the street are talking about me.'
- C. 'Aliens are making my body rot.'
- D. 'The Messiah is watching my every move.'
- E. 'Martians have landed on earth.'
3. A patient is experiencing increased brightness and acuity of visual objects. Intense perceptions occur in all of the following EXCEPT:
- A. Migraine
- B. Hallucinogens
- C. Mania
- D. Delirium
- E. Depression
4. A 12-year-old boy, at a school anniversary celebration, vividly describes what Martians may look like. The imagery is:
- A. A perception
- B. A fantasy
- C. A pseudo-hallucination
- D. An illusion
- E. None of the above
5. 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
6. Which of the following is NOT a common feature of schizophrenic auditory hallucinations?
- A. Being multiple
- B. Male voice
- C. Speaks in one's mother tongue
- D. Often continuously present
- E. Has a different accent
7. Which of the following can cause visual hallucinations?
- A. Occipital lobe tumours
- B. Post-concussion states
- C. Hepatic failure
- D. Dementia
- E. All of the above
8. Which of the following drugs on withdrawal produce disturbed proprioceptive perceptions?
- A. Cannabis
- B. Amphetamines
- C. LSD
- D. Benzodiazepines
- E. Nicotine
9. Which one of the following is NOT matched correctly?
- A. Form of thought: loosening of association
- B. Content of thought: persecutory belief
- C. Stream of thought: poverty of speech
- D. Form of thought: obsessions
- E. Form of thought: circumstantiality
10. Which one of the following is more common in manic rather than schizophrenic speech disturbance?
- A. Clanging
- B. Derailment
- C. Thought blocking
- D. Tangentiality
- E. Poverty of content of speech
11. A patient looks dishevelled, with unkempt hair and dirty, unwashed clothes. Self-neglect is commonly noted in all of the following EXCEPT:
- A. Alcoholism
- B. Chronic schizophrenia
- C. Depression
- D. Dementia
- E. Social phobia
12. A 57-year-old lady with many previous hospitalisations is brought by police to casualty. She is wearing full make-up, green lipstick, shiny green nail polish and green jewellery. She asks everyone at the admission unit to call her Ms Green. Which diagnosis is most consistent with this presentation?
- A. Mania
- B. Depression
- C. Panic attacks
- D. Obsessive compulsive disorder
- E. Learning disability
13. A 33-year-old man attending an out-patient clinic turns towards his left and spits out, muttering unintelligibly. He does this at least three times in half an hour and appears very guarded. This gesture is suggestive of which of the following?
- A. Depression
- B. Suicidal thinking
- C. Low self-esteem
- D. Responding to hallucination
- E. Acute confusion
14. Which of the following is the major difference between mood and affect in the mental state examination?
- A. Mood is short-lived while affect is longer lasting
- B. Mood is objective while affect is subjective
- C. Affect is transient but difficult to interpret
- D. Affect is transient and self-reported
- E. None of the above
15. On physical examination, a person with a history of substance misuse has piloerection, dilated pupils, rhinorrhoea and is yawning frequently. Withdrawal from which of the following substances can cause this presentation?
- A. Cocaine
- B. Opiate
- C. Cannabis
- D. Alcohol
- E. Amphetamines
16. A man admitted to the psychiatric intensive care unit with a manic episode received 10 mg of haloperidol intramuscularly as he had turned violent. He became unresponsive shortly afterwards. On examination there is confusion, labile BP, hyperthermia, rigidity and dysphagia. What is the most important differential diagnosis?
- A. Acute dystonia
- B. Neuroleptic malignant syndrome
- C. Tardive dyskinesia
- D. Akathisia
- E. Parkinsonism
17. Epilepsy associated with learning disability, shagreen patches and ash leaf macules are seen in which of the following?
- A. Epidermal naevus syndrome
- B. Tuberous sclerosis
- C. Neurofibromatosis
- D. Sturge-Weber syndrome
- E. Fabry's disease
18. A 32-year-old school teacher is admitted for constipation and acute abdominal pain. She experiences visual and tactile hallucinations with intense anxiety. She develops motor weakness of her legs on administration of hypnotics and diclofenac. Which laboratory test is indicated?
- A. Serum lipid levels
- B. Serum folate
- C. Urine glucose
- D. Urine porphyrins
- E. Serum ceruloplasmin
19. Which of the following is an advantage of using CT scan over MRI for diagnostic purposes?
- A. Finer details are seen easily with CT scan
- B. Absence of radiation exposure in CT scan
- C. CT scan is more suitable in pregnant women
- D. CT scan is more immediately available in emergencies
- E. Anterior fossa is better visualised with CT scan
20. Which of the following nutrients, if deficient, can make treatment of depression difficult?
- A. B12
- B. Riboflavin
- C. Nicotinamide
- D. Folate
- E. Magnesium
21. Which of the following is the most clinically useful method of diagnosing Alzheimer's disease?
- A. Clinical interview
- B. CT scans
- C. Functional MRI
- D. SPECT
- E. Lumbar puncture
22. Which one of the following can increase plasma levels of lamotrigine?
- A. Lorazepam
- B. Chlorpromazine
- C. Valproate
- D. Carbamazepine
- E. Zopiclone
23. A patient presents with recurrent episodes of feeling detached and unreal. A pharmacological agent that can worsen these symptoms is:
- A. Clozapine
- B. Caffeine
- C. Lamotrigine
- D. Clonazepam
- E. Valproate
24. The ECG changes produced by long-term lithium therapy mimic which one of the following electrolyte disturbances?
- A. Hyperkalaemia
- B. Hypokalaemia
- C. Hypocalcaemia
- D. Hypercalcaemia
- E. Hyperuricaemia
25. 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
26. The most powerful predictors of recurrence of depressive episodes among the following are:
- A. Previous episodes of depression and presence of residual symptoms
- B. Non-bipolar diagnosis and later age of onset
- C. Female gender and earlier age of onset
- D. Higher degree of life events and family history of affective disorders
- E. Male gender and past history of psychiatric admission
27. All of the following factors are significantly associated with increased risk of violence among those with schizophrenia EXCEPT:
- A. Comorbid substance use
- B. Comorbid personality disorder
- C. Acute psychotic symptoms
- D. Non-compliance with treatment
- E. Comorbid depression
28. The most common group of mental disorders diagnosed among homicide offenders is:
- A. Personality disorders
- B. Substance use disorders
- C. Schizophreniform disorders
- D. Affective disorders
- E. Learning disabilities
29. The most powerful predictor of overall functional outcome in children with autism is given by:
- A. Family history of autism
- B. Autistic symptom count
- C. Presence of soft neurological signs
- D. IQ level
- E. Non-verbal skill
30. The estimated heritability of attention deficit hyperactivity disorder (ADHD) is around:
- A. 10%
- B. 25%
- C. 33%
- D. 50%
- E. 70%