Mount Kenya University · School of Medicine · Psychiatry
Paper details
- Paper: 6th Year CATs, October 2023, Mount Kenya University Psychiatry. 20 multiple choice questions with five options each. Answers go on an answer sheet.
- Sitting: October 2023 (the day is not printed). By the timetable October falls in Trimester 1 (September to December).
- Topics tested: violence and schizophrenia, depression and sexual orientation, defence mechanisms, causes of cognitive decline in old age, visual and auditory hallucinations, Freud's id, ego and superego, mood versus affect, withdrawal states, acute porphyria, diagnosis of Alzheimer disease, predictors of relapse in depression, outcome in autism, and the physiology of sleep.
- Repeats: most questions are repeated from the June 2023 CATs. Papers in this unit reuse questions heavily, so these are worth knowing well.
- Note: the scan is a student's marked paper with an answer sheet and a score. They were ignored.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q2, Q5 and Q19 are loosely worded or have more than one defensible option. The explanation says which option is best and why.
Multiple choice questions
1. 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
2. A 35-year-old lesbian was referred to the outpatient clinic with a 4-month history of low mood, particularly in the morning, difficulty sleeping, poor appetite, weight loss and poor concentration. Which statement about her psychiatric history and prognosis is correct compared with a heterosexual female?
- A. A higher risk of suicide
- B. Less likely to be psychologically distressed
- C. Less likely to have alcohol problems
- D. More likely to have self-harmed
- E. Poorer response to antidepressant
3. 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
4. A 35-year-old unmarried lesbian was unaware of her hatred towards her mother. However, she often felt inexplicably resentful towards older women in positions of authority. She could not understand why she had felt like this for several years. Which of the following can explain this situation?
- A. Altruism
- B. Displacement
- C. Idealisation
- D. Projection
- E. Projective identification
5. A 76-year-old man with a history of falls was brought to the clinic because of recent deterioration in his self-care. He appeared malnourished, confused and somewhat unkempt. There was a significant but mild cognitive impairment, and incontinence. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Chronic subdural haematoma
- C. Multi-infarct dementia
- D. Normal pressure hydrocephalus
- E. Pick's disease
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. According to Freud's psychic apparatus, which of the following is concerned with mediating between basic desires and the judicial part of punishment?
- A. Collective unconscious
- B. Dreams
- C. Ego
- D. Id
- E. Super-ego
9. Which of the following drugs on withdrawal produce disturbed proprioceptive perceptions?
- A. Cannabis
- B. Amphetamines
- C. LSD
- D. Benzodiazepines
- E. Nicotine
10. 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
11. 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
12. 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
13. 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
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, you notice that 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 28-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
17. 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
18. 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
19. 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
20. Which of the following statements about sleep is correct?
- A. As the day progresses, the circadian wake drive increases and homeostatic sleep decreases, until a tipping point is reached, and the ventrolateral preoptic sleep promoter is triggered to release GABA in the tuberomammillary nucleus, which increases wakefulness
- B. Homeostatic sleep drive increases with a longer period of sleep and decreases with a period in the awake state
- C. Sleep consists of multiple phases which recur in a cyclical manner known as the ultradian cycle
- D. The diminishing of the circadian wake drive is the result of input to the suprachiasmic nucleus
- E. There is a single process regulating sleep