Clinical Examination Flashcards
A 18-year-old man presents with the bizarre behaviour of picking his clothes and the carpet. He appears agitated and mutters unintelligibly. He has a high temperature on examination. When examining him, it is found that when his knee is extended with flexed hip, he develops a ‘catch’ and flexes the other hip as a reflex. This is called
Select one:
1. Reverse leg raising sign
2. Positive Romberg’s sign
3. Straight leg raising sign
4. Positive Brudzinki’s sign
5. Positive Kernig’s sign
Positive Kernig’s sign
The Kernig’s sign is elicited by flexing one hip and knee and then extending the knee with the hip still
flexed. Hamstring spasm may occur; if severe, opposite knee may flex during the test - this is termed as a positive Kernig’s.
A patient agrees that he has significant problems with the use of alcohol. He takes responsibility and
understands the importance of having a change in his lifestyle. He has not taken any active steps to change his drinking pattern so far and continues heavy alcohol use. Which of the following levels of insight does he have?
Select one:
1. Intellectual insight
2. Complete loss of insight
3. Externalization of cause
4. Emotional insight
5. Awareness of problems but denial of responsibility
Intellectual insight
Intellectual insight: admission that the patient is ill and that symptoms or failures in social adjustment are caused by the patient’s own particular irrational feelings or disturbances without applying this knowledge to future experiences.
Unilateral frontal lobe damage can result in
Select one:
1. Does not cause spastic paresis
2. Contralateral spastic hemiplegia
3. Contralateral hypotonia
4. Ipsilateral spastic hemiplegia
5. Paraplegia
Contralateral spastic hemiplegia
Damage to upper motor neurons originating in frontal motor strip can result in contralateral spastic
hemiparesis.
61-year-old right-handed man presented to the emergency department with an acute onset of right-leg weakness. Soon his weakness progressed to include both arms and legs, and he stopped speaking. On examination, he was alert but produced no spontaneous speech or spontaneous movements. Which artery is most likely to be implicated in this presentation?
Select one:
1. Cerebello Pontine artery
2. Posterior cerebral artery
3. Anterior cerebral artery
4. Middle cerebral artery
5. Basilar artery
Anterior cerebral artery
The syndrome of akinetic mutism is typically the result of bilateral hemispheric injury, usually involving the anterior cingulate gyri. Other lesions producing akinetic mutism include lesions of the thalami, globus pallidus, internal capsule, and frontal white matter. These lesions are thought to disrupt anterior frontal-subcortical circuits that subserve motivation. This is usually a result of anterior cerebral artery occlusion, which in some individuals, can have a predominantly lateralized course due to an anatomical variation on one side.
All of the following drugs will increase urine porphyrins in a susceptible individual with disordered haem metabolism except
Select one:
1. Oestrogens
2. Diclofenac
3. Barbiturates
4. Chlorpromazine
5. Benzodiazepines
Chlorpromazine
Acute intermittent porphyria is episodic in nature and the episodes are often triggered by certain medications including oestrogens, barbiturates and benzodiazepines. Diclofenac can precipitate an episode. Psychiatric manifestations include depression, anxiety, delirium and psychosis.
The brain region with most prominent changes observed using neuroimaging in ADHD is
Select one:
1. Frontal cortex
2. Occipital cortex
3. Thalamus
4. Parietal cortex
5. Insula
Frontal cortex
Frontal brain dysfunction is notable in many unmedicated children with ADHD
In schizophrenia, the anatomical structure in the brain that is most consistently reduced in size is
Select one:
1. striatum
2. insula
3. hypothalamus
4. cerebellum
5. hippocampus
Insula
Most of the listed structures have been observed to have structural abnormalities in schizophrenia. In fact, the hippocampus has been repeatedly shown to have a reduced volume though not in all studies. Insula, which forms a part of the paralimbic cortex, has been unequivocally shown to have volumetric abnormalities in schizophrenia. Other consistently affected structures include anterior cingulate cortex, dorsolateral prefrontal cortex and thalamus.
Which of the following is not a frontal release sign?
Select one:
1. Rooting reflex
2. Glabellar tap
3. Snout reflex
4. Cremasteric reflex
5. Grasp reflex
Cremasteric reflex
Primitive reflexes include the glabellar tap, rooting, snout, sucking, and palmomental reflexes. These are generally absent in adults. When present in the adult, these signs signify diffuse cerebral damage,
particularly of the frontal lobes (hence called frontal-lobe release signs). Cremastric reflex is a superficial reflex.
A lactate solution is infused in a 32-year-old woman. This results in acute anxiety, palpitations, sweating, fear of loss of control and dizziness. What is the most likely diagnosis?
Select one:
1. Lactic acidosis
2. Malingering
3. Generalized anxiety disorder
4. Panic disorder
5. Lactose intolerance
Panic disorder
Nearly 72% patients with panic disorder have a panic attack when administered IV injections of sodium lactate. Therefore, lactate provocation is used to confirm a diagnosis of panic disorder. Hyperventilation and CO2 inhalation have been used. Panic attacks triggered by sodium lactate are not inhibited by peripherally acting beta-blockers but are inhibited by benzodiazepines and tricyclic drugs.
One of the most well established anatomical changes seen in schizophrenia is
Select one:
1. Enlargement of the lateral ventricle
2. Enlargement of corpus callosum
3. Enlargement of the amygdala
4. Enlargement of the third ventricle
5. Enlargement of cerebellar peduncles
Enlargement of the lateral ventricle
A decrease in brain weight, brain length and volume of the cerebral hemispheres enlargement of the lateral ventricles is reported commonly in patients with schizophrenia.
A tremor, which decreases with volitional movements and appears primarily when not engaged in tasks, is most likely to be a
Select one:
1. postural tremor
2. cerebellar ataxia
3. physiologic tremor
4. senile tremor
5. resting tremor
Resting tremor
A resting tremor occurs with the body part in complete repose and often dampens or subsides entirely with action.
In MRS, which nuclei are commonly used for in vivo measure of phosphocreatinine?
Select one:
1. H-1
2. Na-23
3. Li-7
4. F-19
5. P-31
P-31
Na-23 is employed for intra and extra cellular sodium measurement. P-31 is employed for quantifying energy handling and cellular metabolism (ATP/ADP), membrane physiology, phosphomono/ diester quantification and phophocreatinine measurement.
H1 is used for quantifying glutamate, lactate, N-acetylaspartate, choline, creatinine. F-19 MRS is used to study labelled drugs and deoxyglucose.
A patient undergoing an assessment for dementia is asked to draw a circle and place numbers inside the circle to depict the face of a clock. All of the following domains of cognition are crucial for successful completion of this task except.
Select one:
1. Executive function
2. Constructional praxis
3. Comprehension
4. Orientation to time
5. Visuospatial ability
Orientation to time
CDT (Clock Drawing Test) does not assess one’s orientation to time.
Inability to attend to the parts and the whole of an object at the same time is called
Select one:
1. Somatognosia
2. Visuospatial apraxia
3. Prosopognosia
4. Simultanagnosia
5. Anosognosia
Simultanagnosia
Simultanagnosia is characterized by the failure of an individual to perceive more than a single object at a time.
In MMSE, intersecting pentagons test primarily assesses which of the following functions?
Select one:
1. Constructional praxis
2. Language
3. Copying skills
4. Visual retention
5. Orientation
Constructional praxis
Visuospatial ability, especially constructional praxis, is tested using intersecting polygons test.
Which of the following clinical examination for apraxias is abnormal more commonly with a right than a left cerebral damage?
Select one:
1. Imitating a toothbrush action
2. Construction of polygons
3. Mimicking hand movements
4. Using tools appropriately
5. Whistling and coughing on command
Construction of polygons
Constructional apraxia is inability to construct elements to a meaningful whole. E.g. inability to draw or copy simple diagrams or figures. This is typically caused by a lesion in the right cerebral hemisphere.
In a secluded patient, behavioural observation is carried out every 5th minute through a glass window. This
technique is called
Select one:
Event sampling
None of the above
Time sampling
Functional analysis
ABC analysis
Behavioural observation methods include observing and recording behavioural events, to study mental
state or plan intervention. They are of 2 types: Event sampling: e.g. every fifth or tenth event is coded in
detail. Time sampling: observations may be made only every 5 or 10 mins.
The correct answer is: Time sampling
Select the most appropriate investigation for a patient on antipsychotic medications presenting with weight gain, excessive thirst and fatigue.
Select one:
1. Fasting glucose
2. Liver function tests
3. Full blood count
4. Electrocardiogram
5. Fasting lipids
Fasting glucose
The symptoms of weight gain, excessive thirst and fatigue are suggestive of impaired glucose tolerance. A fasting blood glucose is indicated to diagnose antipsychotic related diabetes mellitus.
In occasional cannabis user, how long is cannabis detected in urine after last use?
Select one:
1. 3 hours
2. 4 weeks
3. 12 hours
4. 8 days
5. 3 days
3 days
Occasional use - up to 3 days. High daily use for long time - up to 4 weeks.
A patient presenting with carbon monoxide poisoning is suspected to have bilateral posterior parietal damage due to anoxia. If this turns out to be a case of Balint’s syndrome which of the following will NOT be a presenting feature?
Select one:
1. Simultanagnosia
2. Diplopia
3. Oculomotor apraxia
4. Optic ataxia
5. Intact oculocephalic reflexes
Balint’s syndrome consists of a triad of simultanagnosia (inability to attend to more than one item of a complex scene at a time), optic ataxia (inability to guide reaching or pointing despite adequate vision), and oculomotor apraxia (inability to voluntarily direct saccades to a visual target). Fields may be full when challenged with gross stimuli, and oculocephalic reflexes are intact. This syndrome results from bilateral damage including the superior-parieto-occipital region, which disrupts the dorsal (‘where’) visual processing stream linking visual with parietal association areas. Possible causes include carbon monoxide poisoning, watershed infarction, leucodystrophy, and the posterior cortical variant of Alzheimer’s disease.
Patients with schizophrenia are least likely to perform poorly on which of the following tests?
Select one:
1. Category test
2. Trail B of the Halstead-Reitan battery
3. Wisconsin card sort test
4. Speech sounds perception test
5. MMSE
MMSE
Patients with schizophrenia perform far more poorly than controls on category test (assess higher-order reasoning), Wisconsin card sort test (tests higher-order reasoning), speech sounds perception test, Trail B of the Halstead-Reitan battery (tests the ability to shift flexibility between cognitive sets). Tests of overall cognitive ability such as MMSE are usually intact in schizophrenia.
The investigation that has no helpful role in diagnosing narcolepsy is
Select one:
1. CSF analysis
2. Human leucocyte antigen typing
3. Multiple Sleep Latency test
4. Sleep polysomnogram
5. Sleep deprivation test
Sleep deprivation test
Sleep deprivation test is not helpful to diagnose narcolepsy. The multiple sleep latency test is helpful in supporting the diagnosis. Findings in sleep polysomnogram include sleep latency of less than 10 min and sleep-onset rapid eye movement (REM) periods. There is a strong association with the HLA-DQB1*0602 marker in almost all individuals regardless of ethnicity. An abnormally low concentration of hypocretin-1 (orexin-A) is noted in CSF. In some cases, human leukocyte antigen typing may be helpful in determining whether narcolepsy is likely caused by a lack of hypocretin or another cause.
Which of the following arteries on occlusion leads to symptoms suggestive of dorsolateral prefrontal
dysfunction?
Select one:
1. Middle cerebral
2. Peduncular Check Check
3. Basilar
4. Posterior cerebral
5. Anterior cerebral
Middle cerebral
DLPFC consists of the lateral portions of Brodmann areas 9 - 12, areas 45, 46, and the superior part of
area 47. These regions receive their blood supply from the middle cerebral artery.
During the course of a clinical interview, the psychiatrist says, ‘So from what you have been telling me, your sleep is poor, you have excessive disturbing thoughts and you have lost weight in last 2 months. Is that right?’ What technique is he using?
Select one:
1. Interpretation
2. Summation
3. Facilitation
4. Clarification
5. Repetition
Summation
Summation is brief summarisation of what the patient has said up to a point in the interview. Helps the patient to check if he has said what he intended to say. Helps the doctor to form an idea of the narration so far.
An anorexic patient repeatedly vomits. Which of the following is a possible complication?
Select one:
1. None of the above
2. Hyponatraemia
3. Hypokalaemia
4. Metabolic alkalosis
5. Metabolic acidosis
Metabolic alkalosis
Loss of gastric acid can lead to metabolic alkalosis.
A girl attending your outpatient unit is 165 cm tall and weighs 50kg. What is her body mass index?
Select one:
1. 20 to 21
2. 16 to 17
3. 17 to 18
4. 18 to 19
5. 19 to 20
18 to 19
BMI can be calculated using the formula weight /(squared value of height). The weight must be in kgs and height must be in meters.
All of the following help localizing a neurological lesion to cerebellum EXCEPT
Select one:
1. Ankle clonus
2. Hypotonia
3. Dysdiadochokinesia
4. Ataxia
5. Past pointing
Ankle clonus
Cerebellar signs: Ataxia, hypotonia, dyssynergia (incoordination), dysmetria (past pointing),
dysdiadochokinesis, dysrhythmia and dysarthria.
Which of the following investigations involve introducing a synthetic radionucleotide for obtaining brain images?
Select one:
1. T2 weighted scan
2. PET scan
3. fMRI
4. T1 weighted scan
5. Diffusion Imaging
PET scan
PET involves using radionucleotides to study neuronal activity, neurochemistry and pharmacology of the brain.
In SPECT imaging iomazenil (I-123) is used to label
Select one:
1. GABA-A receptors
2. D-2 receptors
3. Alpha-2 receptors
4. 5-HT2 receptors
5. Glycine receptors
GABA-A receptors
Iomazenil is used for GABA-A receptors.
Alexia without agraphia (pure alexia) is seen in lesions of
Select one:
1. Middle meningeal artery
2. Posterior inferior cerebellar artery
3. Middle cerebral territory
4. Posterior cerebral territory
5. Anterior cerebral territory
Posterior cerebral territory
In alexia without agraphia or pure word blindness, patients retain the ability to write, but are unable to read (even words that they have just written) and often have right homonymous hemianopia. This disorder results from the loss of visual input to the language area [usually the dominant (left) angular gyrus] without the involvement of the language area or output from the language area to the motor cortex. The ability to process visual input into language (i.e. reading) is lost in these patients. The pathways involved in this syndrome are believed to be localized to the inferior portion of the splenium of the corpus callosum on the side of the dominant (usually left) cerebral hemisphere. This is associated with posterior cerebral artery damage.
Which one of the following has been used in vitro as a powerful method of analytical chemistry and enables the measurement of the concentration of different metabolites in the brain?
Select one:
1. Structural MRI scan
2. CT Scan
3. Functional MRI scan
4. X-Ray
5. Magnetic Resonance Spectroscopy.
Magnetic Resonance Spectroscopy.
MRS utilizes the principle of nuclear magnetic resonance and can be used to measure metabolite
concentration without the need for radio isotopes.
The wavelet of EEG that is greater than 13Hz in frequency is
Select one:
1. Delta
2. Beta
3. Theta
4. Gamma
5. Alpha
Beta
Beta is the frequency range from 12 Hz to about 30 Hz.
A patient who sustained a head injury reports loss of memory for events that happened between 13th
September 2014 and 20th September 2014, though he retained full consciousness soon after the injury was sustained on 13th September 2014. Which of the following cognitive dysfunctions is he describing?
Select one:
1. Semantic dementia
2. Retrograde amnesia
3. Selective amnesia
4. Transient global amnesia
5. Anterograde amnesia
Anterograde amnesia
Anterograde memory refers to the newly encountered information from the time of a lesion. Anterograde memory loss is also commonly elicited when examining a dementing patient - e.g. forgetting appointments, losing items around the home, inability to remember conversation leading to repeated questions, etc.
A 32-year-old school teacher is admitted for constipation and acute abdominal pain. She develops motor weakness of her legs on the administration of hypnotics and diclofenac. She experiences visual and tactile hallucinations with intense anxiety. Which of the following laboratory test is indicated?
Select one:
1. Serum folate
2. Urine porphyrins
3. Serum lipid levels
4. Serum ceruloplasmin
5. Urine glucose
Urine porphyrins
The scenario depicts acute intermittent porphyria (AIP). It is one of the groups of disorders of haem
metabolism, characterised by neurological and psychiatric manifestations without obvious cutaneous markers. AIP manifests itself by abdomen pain, neuropathies, and constipation, but, unlike most types of porphyria, patients with AIP do not have a rash. It is an autosomal dominant disorder with the presentation starting between ages 18 and 40. It is episodic in nature and the episodes are often triggered by certain medications including estrogens, barbiturates and benzodiazepines. Diclofenac can precipitate an episode. Psychiatric manifestations include depression, anxiety, delirium and psychosis. Most important lab test is demonstrating increased urinary porphobilinogen during acute attacks. Treatment is aimed at reducing haem synthesis by administering haemin.
Which neuroimaging modality can give information about metabolic changes in the brain?
Select one:
1. Structural MRI Scan
2. PET scan
3. Ultrasonogram brain
4. SPECT scan
5. CAT scan
PET scan
Both PET and SPECT scan give information about regional cerebral blood flow and ligand binding but PET scan also gives information about metabolic changes in the brain. The most commonly used isotopes in PET are fluorine-18, nitrogen-13, and oxygen-15. These isotopes are usually linked to another molecule, except in the case of oxygen-15 (15O). The most commonly reported ligand has been [18F]fluorodeoxyglucose (FDG). This gives information directly about neuronal metabolism.
Which of the following will you use to assess orientation in a hospitalised patient?
Select one:
1. Ability to repeat a phone number immediately after reading out
2. Tap the table once whenever the examiner reads letter ‘E’ from a random list of
alphabets
3. Ability to recognise pictures of famous personalities
4. Ability to correctly identify the doctor when asked to point out
5. Ability to remember his/her own address
Ability to correctly identify the doctor when asked to point out
Orientation to person is a stable domain which is generally lost only late in the course of a confusional state.
Inability to recognise familiar faces is seen in
Select one:
1. Anosognosia
2. Simultanagnosia
3. Prosopognosia
4. Somatognosia
5. Visuospatial apraxia
Prosopognosia
Prosopagnosia (face blindness) is a disorder of face perception where the ability to recognize faces is
impaired.
T1 images in MRI are mostly useful for
Select one:
1. Assessment of normal brain structure
2. Visualising periventricular structures
3. Visualising oedema
4. Detecting tumours
5. Localising ischemic zones
Assessment of normal brain structure
The T1 image most closely resembles a CT scan and is most useful for assessing the overall brain
structure. T1 is also the only sequence that allows contrast enhancement with the contrast agent
gadolinium-diethylenetriamine pentaacetic acid (gadolinium-DTPA).
The earliest appearance of brain atrophy in Alzheimer’s disease is most marked in which of the following brain regions?
Select one:
1. Insular lobe
2. Medial Temporal Lobe
3. Frontal lobe
4. Occipital lobe
5. Posterior Parietal Lobe
Medial Temporal Lobe
Regional atrophic changes observed in MRI studies reveal consistent associations between atrophic
changes of the medial temporal substructures (in particular hippocampus and amygdala) and amnesic deficits, or measures of the global severity of cognitive deficits.
REM pattern is recorded during daytime in a student who is studying for exams for the last two weeks. The most likely reason is
Select one:
1. Delirium
2. Antipsychotic use
3. Cocaine intoxication
4. Sleep deprivation
5. Normal pattern
Sleep deprivation
REM sleep during daytime can be seen in narcolepsy, sleep deprivation or withdrawal from stimulants.
Mr. X has been consuming a high dose of cannabis for a long time. How long will it be present in his urine?
Select one:
1. 24 hours
2. 10 days
3. 3 days
4. 7 days
5. 4 weeks
4 weeks
Cannabis can be detected in urine after occasional use for up to 3 days. After a high daily use for long time, urine drug screen can be positive for up to 4 weeks.
Mrs Y is an elderly lady with cognitive impairment and visual hallucinations. Select the best imaging
technique to diagnose her condition.
Select one:
1. CT scan
2. PET scan
3. DAT scan
4. f-MRI scan
5. MRI Scan
DAT scan
The diagnosis is most likely to be Lewy body dementia as cognitive impairment and visual hallucinations are common. The SPECT ligands 123I-FP-CIT (N-fluropropyl-2ß-carbomethoxy-3ß-4-[123I] iodophenyl tropane), 123I-ß-CIT, and the PET ligand 18F-dopa ([I18F] fluorodopa) can be used to image the presynaptic dopaminergic terminals in the corpus striatum, which are greatly reduced in Lewy body dementia (in contrast to Alzheimer’s). The 123I-FP-CIT agent is also known commercially as the
‘DaTSCAN’.
A patient is asked to hold out both arms with palms facing upwards and maintain the posture with eyes
closed. His left arm slowly drops down compared to right arm. Which of the following lesions is most likely to be present?
Select one:
1. Left hemisphere lesion
2. Cranial nerve X nuclei lesion
3. Cerebellar vermis lesion
4. Right cerebral hemisphere lesion
5. Thoracic spinal cord lesion at T12
Right cerebral hemisphere lesion
A pronator drift is elicited by having the patient extend both arms with the wrists supinated and palms facing upwards and eyes closed - slow unequal drift towards pronation indicates hemiparetic weakness. The left arm drop in this case indicates a right cerebral lesion.
Which phenomenon is commonly used in a functional MRI scan to make inferences about brain activity?
Select one:
1. Echo planar imaging (EPI)
2. Diffusion imaging
3. High angle low-frequency pulses.
4. Blood oxygen level dependent (BOLD) Phenomenon
5. Fast low angle shot radiofrequency pulses (FLASH)
Blood oxygen level dependent (BOLD) Phenomenon
The most commonly used functional MRI (fMRI) method is based on the observation that functional
activation results in an increase in cerebral cortical blood flow that is in excess of oxygen extraction. The result is a local and temporary increase in oxyhaemoglobin. The differences in the magnetic properties of oxy and de-oxy haemoglobin can be used to compute images of regional functional activation patterns (Blood oxygen level dependent-BOLD principle).
Which of the following tests would be required to make a diagnosis of Huntington’s disease in a patient without a family history?
Select one:
1. EEG
2. Immunological tests
3. Sleep studies
4. Gene testing
5. Electromyography
Gene testing
Sporadic appearance of new mutations is not uncommon in the Huntington disease gene. Hence, a genetic test is advised even in those who present without a family history.
Blood oxygen level dependent measurement BOLD is a technique used in which of the following imaging modalities?
Select one:
1. MRS spectroscopy
2. SPECT scan
3. Functional MRI
4. Contrast CT
5. PET scan
Functional MRI
Neuronal activity within the brain causes a local increase in blood flow, which in turn increases the local haemoglobin concentration. Although neuronal metabolism extracts more oxygen in active areas of the brain, the net effect of neuronal activity is to increase the local amount of oxygenated haemoglobin. This change can be detected with the T2 sequence, called Blood Oxygen Level Dependent (BOLD) technique. This
process is the basis for the technique of fMRI.
A diabetic patient who is taking antidepressants is noted to have polyuria and polydipsia. His urine and plasma osmolality are both low. Choose the most likely cause for his presentation.
Select one:
1. Psychogenic polydipsia
2. Hyponatraemia
3. Diabetes insipidus
4. Hyperglycaemia
5. SIADH
Psychogenic polydipsia
Antidepressant induced SIADH does not appear to be dose related, however it does appear to be more
common with serotonergic agents. When both urine and plasma osmolality is low, this indicates that
excessive water is being consumed and excreted - this is seen in psychogenic polydipsia. In
hyperglycemia, plasma osmolality will not be reduced; in SIADH, urine osmolality will be high.
A non-invasive perfusion MRI methodology used to quantify cerebral blood flow is
Select one:
1. Functional MRI
2. Single photon emission tomography
3. Resting state connectivity
4. Diffusion tensor imaging
5. Arterial spin labelling
Arterial spin labelling
Arterial spin labelling is a non-invasive perfusion MRI methodology used to quantify cerebral blood flow.
A 24-year-old man who is being investigated for jaundice presents with a gradual change in personality characterised by disinhibition and recklessness. On examination, he has tremors and dysarthria. Which of the following signs is highly likely in this case?
Select one:
1. Xanthomas on extensor aspect of forearm
2. Golden brown pigmentation around cornea
3. Port wine stain on face
4. Ash leaf macules
5. Cafe au lait spots
Golden brown pigmentation around cornea
This scenario is suggestive of Wilson disease with features of dysarthria, tremor, jaundice and a change in personality. Wilson disease is characterised by the presence of a Kayser-Fleischer ring (brown pigmentation due to copper deposition around cornea).
A 29-year-old man presents with multiple abdominal scars from different surgeries, giving an appearance of checker board abdomen. What is the most likely psychiatric cause?
Select one:
1. Conversion disorder
2. Delusional disorder
3. Hypochondriasis
4. Dissociative disorder
5. Factitious disorder
Factitious disorder
Factitious disorder is defined by DSM-IV as the intentional production of physical or psychological
symptoms. This patient’s repeated presentation to a surgical ward ( probably with various pain symptoms leading to surgeries) is suggestive of a factitious disorder.
Which of the following laboratory tests should be conducted prior to initiating lithium treatment?
Select one:
1. Alkaline phosphatase
2. Thyroid-stimulating hormone (TSH)
3. Platelet count
4. Erythrocyte sedimentation rate
5. Calcium
Thyroid-stimulating hormone (TSH)
As the presence of anti-TSH antibodies can result in hypothyroidism when overlooked, a test for TSH can
come handy before starting lithium.
Which of the following is an advantage of CT scans over MRI?
Select one:
1. Gray vs. white matter demarcation is well delineated
2. Posterior fossa lesions are well noted
3. Multiplanar images are obtained
4. Lesions close to bone are better seen
5. Calcified lesions are better visualised
Calcified lesions are better visualised
The only component of the brain better seen on CT scanning is calcification, which may be invisible on MRI.
On mini-mental examination, a 74-year-old man loses all points on orientation to time and recall, while other faculties are intact. How many points has he lost in total?
Select one:
1. Six
2. Sixteen
3. Thirteen
4. Five
5. Eight
Eight
5 points are awarded for orientation in time and 3 points for recall.
Generalised diffuse delta and theta waves in the EEG are seen in
Select one:
1. Temporal lobe seizures
2. Metabolic encephalopathy
3. Infantile spasms
4. CJD
5. Normal Stage 1 sleep
Metabolic encephalopathy
An EEG showing diffuse slowing of the background and presence of triphasic waves is highly suggestive of a metabolic encephalopathy. Triphasic waves are high amplitude (200 to 300 µV), usually bilaterally
synchronous, symmetrical, and maximum in amplitude over the frontocentral regions.
When copying a complex figure, a patient with brain injury manages to reproduce global features of the design but misses the finer details of the figure. He is most likely to have
Select one:
1. Angular gyrus lesion
2. Bilateral damage
3. Right hemisphere damage
4. Fusiform gyrus lesion
5. Left hemisphere damage
Left hemisphere damage
While performing Rey Osterreich Complex figure test, patients with right hemisphere damage fail to
reproduce global pattern but copy isolated details. Those with left sided damage capture the global figure but not the finer details.
Amphetamines could be detected in urine for up to
Select one:
1. 48 hours
2. 30 days
3. 6 hours
4. 24 hours
5. 7 days
48 hours
Amphetamines, codeine and morphine could be detected in urine for up to 48 hours.
An important investigation useful to differentiate Lewy body dementia from Alzheimer’s disease is
Select one:
1. MRI scan
2. CT scan
3. X-ray
4. EEG
5. DaT scan
DaT scan
DaTSCAN is a drug used as part of a diagnostic procedure called SPECT imaging. DaTSCAN SPECT is
indicated for detecting loss of functional dopaminergic neuron terminals in the striatum. The sensitivity of the FP-CIT scan for the diagnosis of DLB is 88% and specificity is 100 % .It helps to differentiate probable dementia with Lewy bodies from Alzheimer’s disease.
Which of the following is NOT a good practice while using interpreters?
Select one:
1. Ask the interpreter about patient’s guarded nature while answering
2. Offering to debrief the interpreter if needed after interpretation
3. Encourage interpretation and then translation of mental status examination
4. Brief the interpreter before seeing the patient.
5. Sticking to the same interpreter for a single case
Encourage interpretation and then translation of mental status examination
When using an interpreter, explain the need for providing a literal translation of a patient’s account. If the interpreter provides a ‘summarised translation’ or ‘interpretations’ of the reported account, several salient aspects may be missed during a Mental Status Examination.
Various components of language that must be tested in order to localize the brain lesion causing aphasia include all EXCEPT
Select one:
1. copying
2. comprehension
3. naming
4. Repetition
5. fluency
Copying
Reading, writing, repetition, fluency, comprehension and naming are tested to localize aphasia.
In which of the following situations closed questioning is a useful technique?
Select one:
1. In a highly distracted patient
2. To interview an overtalkative patient
3. At the later part of interview
4. To rule out less likely symptoms
5. All of the above
All of the above
Closed questions are better avoided in early parts of interview as they can produce prescribed answers
lacking in detail. Close questions must be avoided in highly suggestible patients. A good technique is to
start with open; move to closed by the end of the interview. Useful to rule out less likely symptoms. The answers for closed questions can only be ‘yes’ or ‘no’, in most occasions. When clubbed with non-facilitative gestures, can be detrimental to interview process. Stating a presumption followed by tags can be very directive.
Which of the following speech best describes Broca’s aphasia?
Select one:
1. Non-fluent aphasia
2. Fluent aphasia
3. Telegraphic speech
4. Scanning speech
5. Staccato speech
Non-fluent aphasia
In Broca’s aphasia, due to damage to the motor speech zone, the language appears non-fluent.
A previously reliable and conscientious man has become increasingly profane, irascible, and irresponsible over the past 3 - 6 months. These symptoms suggest that a tumour, if present, is most likely to be located in the
Select one:
1. Medial wall
2. Temporal Lobe
3. Parietal Lobe
4. Cerebellum
5. Frontal lobe
Frontal lobe
Personality change is a frequent feature of frontal lobe damage; it is also seen in late phases of Alzheimer’s where posteriorly begun degeneration and plaque formation gradually encroaches on the frontal regions.
Which of the following conditions, when suspected, will necessitate performing a neurological procedure called Hoover’s test?
Select one:
1. Depression
2. Conversion disorder
3. Somatisation disorder
4. Munchausen syndrome
5. Hypochondriasis
Conversion disorder
Hoover’s test is useful to identify patients with conversion disorder, who has paralysis with One or more limbs or one side of the face or body may be affected. Here the patient is unable to raise the affected limb from the couch but can raise the unaffected limb against resistance with demonstrable pressing down of the heel on the affected side.
Failure of object recognition despite normal sensory input and motor functions is called
Select one:
1. Visual agnosia
2. Prosopagnosia
3. Astereognosis
4. Anosognosia
5. Neglect
Visual agnosia
Visual object agnosias cause a failure of object recognition despite adequate perception. Those with apperceptive visual agnosia have normal basic visual functions, but fail on more complex tasks involving object identification and naming
Which of the following has a white, bright appearance in a CT scan?
Select one:
1. White matter
2. Haemorrhage
3. Brain tumour
4. Brain oedema
5. CSF
Haemorrhage
Blood appears bright in CT and T1 MRI.
During a clinical interview, a doctor tells her patient ‘I am impressed by what you have achieved’. What type of statement is this?
Select one:
1. Normalisation
2. Counter-transference
3. Validation
4. Negative therapeutic alliance
5. Statement of respect
Statement of respect
Affirmative statements that are genuine and appropriate indicating respect and dignity offer positive reinforcement during a psychiatric interview.
The most common opportunistic infection in a patient with AIDS is
Select one:
1. Leprosy
2. Toxoplasma
3. Cytomegalo virus
4. Cryptococcus
5. Syphilis
Toxoplasma
Toxoplasmosis is common in AIDS. Brain imaging shows multiple ring-shaped contrast enhancing lesions. MRI is considered superior to CT scanning with IV contrast material with either modality improving the diagnostic yield and accuracy.
All of the following are signs of an upper motor neuron (UMN) lesion except
Select one:
1. Spasticity
2. Rigidity
3. Muscular atrophy
4. Extensor plantar
5. Weakness
Muscular atrophy
Atrophy is seen in LMN lesions, not in UMN lesions.
Which of the following questions is useful in evaluating immediate recall?
Select one:
1. Can you tell me today’s date?
2. Where were you yesterday?
3. What did you have for dinner?
4. Where did you go to school?
5. Can you repeat these six numbers?
Can you repeat these six numbers?
Digit span reflects one’s ability to retain information in the short-term memory store. Along with free
recall of items, it is an often used test for immediate recall.
In a motorbike accident, a 21-year-old driver sustains significant head injury. Following recovery from emergency neurological status, it is found that he has significant cognitive deficits. Which of the following is NOT a test of parietal lobe functioning?
Select one:
1. Two point discrimination
2. Right left orientation
3. Lexical fluency
4. Stereognosis
5. Finger agnosia
Lexical fluency
Lexical fluency is a frontal lobe test, whereas Stereognosis, finger agnosia, Right left orientation, two point discrimination are tests for parietal lobe.
Anomic dysphasia is suggestive of a lesion in which of the following regions of the brain?
Select one:
1. Dominant fronto-temporal lesion
2. Non-dominant fronto-temporal lesion
3. Dominant temporo-parietal lesion
4. Non-dominant temporo-parietal lesion
5. Dominant occipital lesion
Dominant temporo-parietal lesion
In anomic dysphasia, confrontation naming is affected more than any other function (when an object is shown, the patient cannot tell its name). It is often due to small left-sided lesions in language cortex - temporo-parietal junction.
A 32-year-old man has left his wife and children without informing them, has travelled a long distance and has taken up a new name to avoid being found. He is drinking heavily, appears depressed and suicidal. Physical examination is unremarkable except for generalized lymph node enlargement and some muscle wasting. Which of the following is a likely diagnosis?
Select one:
1. Major depression
2. Alcohol dependence
3. Dissociative fugue
4. HIV illness
5. Lymphoma
HIV illness
Generalised lymph node enlargement with muscle wasting along with social withdrawal (possibly due to perceived stigma) is suggestive of a HIV illness.
Which of the following is characteristic of a senile pupil?
Select one:
1. Sluggish light and accommodation reaction
2. Sluggish accommodation reaction; preserved light reaction
3. Exaggerated accommodation and light reaction
4. Preserved accommodation reaction; sluggish light reaction
5. No changes in light and accommodation reaction
Sluggish light and accommodation reaction
The pupil size becomes smaller with aging. This constricting of pupil is called senile miosis; the pupil
becomes sluggish to light and accommodation.
A depressed patient who is having difficulties with alcohol use is attempting to narrate her problems
regarding her job, but stops after initiating the discussion. The examiner praises the patient for doing well despite having a difficult time. Which of the following interview technique is he using?
Select one:
1. Setting traps
2. Reinforcement
3. Acknowledgment of affect
4. Suggestive lead
5. Validation
Reinforcement
Reinforcement aids in further disclosure and continuation of a diagnostic interview.
Inappropriate lack of concern about a functional deficit or disability is known as
Select one:
1. Anosognosia
2. Prosopagnosia
3. La belle indifference
4. Perseveration
5. Alexithymia
La belle indifference
La belle indifference is the inappropriate lack of concern about the deficit or disability. It is seen in hysteria (conversion disorders), and also in some cases with multiple sclerosis. In anosognosia, the patient either refuses to acknowledge the deficit or disowns the deficit. In contrast, patients with la belle indifference appreciate the deficit but show no emotional concern.
A patient can follow commands and repeat phrases, but he has an incomprehensible speech. He is likely to have
Select one:
1. Transcortical aphasia
2. Conduction aphasia
3. Broca’s aphasia
4. Wernicke’s aphasia
5. Dyscalculia
Transcortical aphasia
In transcortical motor aphasia repetition and comprehension are intact. In transcortical sensory aphasia, speech is fluent, repetition is intact and comprehension is impaired.
Which of the following tasks is most useful in evaluating a patient’s ability to concentrate?
Select one:
1. Naming five large cities
2. Reporting current world events
3. 3 items recall
4. Performing serial 7s
5. Estimating the distance between Sheffield and London
Performing serial 7s
Serial Sevens is a clinical test that forms a part of the Mini Mental Status Examination; it is a quick and easy test of concentration and memory, used especially if there is a clinical suspicion of cognitive dysfunction.
The symptom or sign that responds earlier than others when thiamine is replaced in a patient with
Wernicke’s encephalopathy is
Select one:
1. Ophthalmoplegia
2. Apathy
3. Confusion
4. Ataxia
5. Amnesia
Ophthalmoplegia
Ophthalmoplegia responds within hours, but cognitive impairment takes longer.
Copying intersecting polygons in MMSE tests the functions of
Select one:
1. Hippocampus
2. Parietal lobes
3. Temporal lobes
4. Cerebellum
5. Frontal lobes
Parietal lobes
Visuospatial ability is a function of parietal lobes.
All of the following techniques are useful in facilitating disclosure EXCEPT
Select one:
1. Silence
2. Positive reinforcement
3. Acknowledgement of affect
4. Suggestive questions
5. Validation
Suggestive questions
Suggestive questions have answers that are contained in the question itself. This misleads both the patient and the doctor. The patient is often left with little choice than to agree with the suggestion.
Wernicke’s encephalopathy is directly caused by a deficiency of
Select one:
1. Thiamine
2. Alcohol dehydrogenase
3. Riboflavin
4. Niacin
5. Aldehyde
Thiamine
Wernicke’s encephalopathy (WE) is directly caused by thiamine deficiency, due to inadequate dietary
intake, reduced gastrointestinal absorption, decreased hepatic storage, and impaired utilization. Not every thiamine-deficient alcoholic develops WE. A vulnerability elated to abnormal thiamine-dependent transketolase may result in reduced affinity for sparsely available thiamine.
A forensic inpatient is asked to undergo narcoanalysis by the Crown Court. Which of the following statements about narcoanalysis is NOT true?
Select one:
1. Useful technique when repression and dissociation are suspected.
2. Organic muteness gets better with amobarbital infusion
3. Psychogenic muteness gets better with amobarbital infusion
4. Amobarbital is used
5. Benzodiazepines can be used
Organic muteness gets better with amobarbital infusion
Interviews with amobarbital have both diagnostic and therapeutic indications. These are sometimes helpful in differentiating nonorganic and organic conditions, particularly in patients with symptoms of catatonia, stupor, and muteness. Organic conditions tend to worsen with infusions of amobarbital, but nonorganic or psychogenic conditions tend to get better because of disinhibition, decreased anxiety, or increased
relaxation. Therapeutically, amobarbital interviews are useful in disorders of repression and dissociation such as amnesia and fugue. Benzodiazepines can be substituted for amobarbital.
Which of the following SPECT finding is seen in Alzheimer’s disease?
Select one:
1. Multiple zones of ischemia in left hemisphere
2. Increase in temporal perfusion
3. Increase in parietal perfusion
4. Increase in frontal perfusion
5. Decrease in temporal perfusion
Decrease in temporal perfusion
Numerous studies have suggested that temporoparietal hypoperfusion seen on brain imaging with SPECT may be useful in diagnosing Alzheimer’s disease.
Basal ganglia is implicated in a type of memory that deals with skills, habits, and nonassociative learning
and does not require conscious awareness and concentration, and usually remains intact after brain injury. This type of memory is called
Select one:
1. Implicit memory
2. Flash-bulb memory
3. Insight memory
4. Episodic memory
5. Declarative memory
Implicit memory
Nondeclarative memory, also known as implicit memory, deals with skills, habits, and non-associative learning that do not require conscious awareness and concentration. Nondeclarative memory often remains intact in patients with brain injury. Brain regions crucial for nondeclarative memory include basal ganglia, limbic system, and somatosensory cortices.
Which region of the brain is often highlighted when performing tasks inside a scanner during a functional MRI scan?
Select one:
1. Thalamus
2. Basal ganglia
3. Cerebellum
4. Primary motor cortex
5. Hypothalamus
Primary motor cortex
The region of the brain that is often highlighted by functional MRI scan is the primary motor cortex.
Which of the following is not a functional neuroimaging technique?
Select one:
1. fMRI scan
2. Single positron emission computerised tomography
3. Positron emission tomography
4. Magnetoencephalography
5. Digital subtraction angiography
Digital subtraction angiography
Functional neuroimaging measures an aspect of brain function to understand the relationship between activity in certain brain areas and specific mental functions. Common methods of functional neuroimaging include SPECT, PET, fMRI, EEG and NIRS (near infra-red spectroscopic imaging). Digital Subtraction Angiography (DSA) is a powerful technique for the visualization of blood vessels in the human body. DSA is a fluoroscopy technique to visualize blood vessels in a bony or dense, soft tissue area. It does not measure brain function as such but identifies abnormalities in the integrity of cerebral vasculature.
Confrontation test carried out during physical examination is useful to detect which one of the following?
Select one:
1. Astigmatism
2. Myopia
3. Cerebellar lesions
4. Lens dislocation
5. Lesions of optic tract
Lesions of optic tract
Confrontation test is used to assess the central visual field by using a red pin.
Which of the following is a compound question?
Select one:
1. I think you are not well. Am I right?
2. What can I do for you?
3. What is the average height of British women?
4. Do you know how IQ is calculated?
5. Do you go on holidays and are you able to relax then?
Do you go on holidays and are you able to relax then?
Adding two or more questions in a single statement is referred to as a compound question (consider MCQs - they are always compound). This confuses the patient and may lead to either a vague response or no response.
Letter cancellation, star cancellation and line bisection tasks examine which of the following cognitive dysfunction?
Select one:
1. Visual neglect
2. Apraxia
3. Agraphia
4. Disorientation
5. Acalculia
Visual neglect
Neglect of personal and extrapersonal space (visual neglect) is usually caused by lesions to the right hemisphere - usually the inferior parietal or prefrontal regions. Deficits can be uncovered by simultaneous bilateral sensory or visual stimulation, or having the patient bisect lines of variable length. Letter and star cancellation tasks are similar, more formal tasks.
A 29-year-old African-American man who uses intravenous heroin presents with a puffy face and steady increase in weight despite normal appetite. On examination his blood pressure is 150/100mmHg. The most likely diagnosis is
Select one:
1. Hepatitis B liver disease
2. Hypothyroidism
3. Opiate withdrawal
4. Nephropathy
5. HIV seroconversion
Nephropathy
Heroin-associated nephropathy includes different morphological findings following chronic drug abuse. The exact cause of renal damage is still ambiguous. Some suspect heroin itself, while others blame adulterants, other diseases like hepatitis B and C infection or HIV, as the causative factors for a spectrum of morphologically variable changes in the kidneys. ( Heroin-associated nephropathy,
The correct answer is:
Clinical features of drug-induced hyponatraemia include
Select one:
1. Muscle cramps
2. Constipation
3. Diarrhoea
4. Tremors
5. Sweating
Muscle cramps
Signs and symptoms of hyponatremia include nausea and vomiting, headache, confusion, lethargy, fatigue, appetite loss, muscle cramps and restlessness with irritability.
Which of the following signs can be elicited by having the patient extend both arms with the wrists dorsiflexed and palms facing forward and eyes closed?
Select one:
1. Chorea
2. Myoclonus
3. Asterixis
4. Athetosis
5. Pronator drift
Asterixis
Asterixis can be elicited by having the patient extend both arms with the wrists dorsiflexed and palms facing forward and eyes closed. Brief jerky downward movements of the wrist are considered a positive sign. Asterixis is commonly seen with metabolic encephalopathies.
The correct answer is:
If you perform a routine cognitive examination on a 90-year-old woman with no history suggestive of dementia, which of the following is least likely to be seen?
Select one:
1. Reduced new learning efficiency
2. Reduced working memory
3. Reduced visuospatial ability
4. Reduced motor speed
5. Reduced attentional span
Reduced working memory
Reduced short-term, working memory is a feature of dementia. It is not expected as a part of healthy aging. But reduced motor speed, visuospatial skills, attentional span, and decreased new learning ability are seen in healthy aging process.
The presence of intracytoplasmic inclusion bodies is a microscopic finding in which of the following conditions?
Select one:
1. Alcoholic dementia
2. Lewy body dementia
3. Alzeimer’s disease
4. Creutzfeldt-Jakob disease
5. Huntington’s disease
Lewy body dementia
Lewy Bodies are spherical intraneuronal cytoplasmic inclusions 15-30um in diameter and are found in the brainstem of patients with Parkinson’s disease. In DLB, these abnormal proteins are found diffusely throughout other areas of the brain including midbrain and the cerebral cortex.
Grey matter reduction is seen in patients with psychosis. The transition of patients
from ultra high risk to psychotic patients involves a volume reduction in which part of the brain region?
Select one:
1. Prefrontal cortex
2. Caudate nucleus
3. Cerebellum
4. Superior temporal gyrus
5. Hippocampus
Prefrontal cortex
A study performed using Magnetic resonance imaging to examine grey matter volumes of the superior temporal gyrus and its subregions (planum polare, Heschl’s gyrus, planum temporale, and rostral and
caudal regions) in 97 antipsychotic-naive individuals at ultra-high risk of psychosis, of whom 31 subsequently developed psychosis and 66 did not, and 42 controls. Those at risk of psychosis had significantly smaller superior temporal gyri at baseline compared with controls bilaterally, without any prominent subregional effect; however, there was no difference between those who did and did not subsequently develop psychosis. A large number of transition related studies have been conducted since the Takahashi paper in 2009 which had a limited sample. The emerging large-scale studies indicate more prefrontal than superior temporal reduction. Inparticular, a multisite longitudinal study (NAPLS) reported that CHR subjects who converted to psychosis showed a steeper rate of gray matter loss in the right superior frontal, middle frontal, and medial orbitofrontal cortical regions as
well as a greater rate of expansion of the third ventricle compared with CHR subjects who did not convert to psychosis and healthy control subjects. With this in mind, the best answer is prefrontal cortex.
Which of the following statements is true concerning bedside tests of orientation?
Select one:
1. Most patients do not remember the length of time spent in hospital in spite of intact orientation.
2. Orientation to time is often affected in delirium
3. Disorientation to one’s own name indicates hippocampal lesions
4. Intact orientation excludes memory disorders
5. Orientation to person is the most sensitive test
Orientation to time is often affected in delirium
Orientation is usually assessed to time, place and person; it is not particularly sensitive, and intact orientation does not exclude a significant memory disorder, particularly if there is concern about memory from an informant. Time orientation is the most helpful, and should include the time of day. Many normal
people do not know the exact date, and being out by two days or less is considered normal when scoring this formally. Time intervals are often poorly monitored by patients with delirium, moderate to severe
dementia, and in the amnesic syndrome, and are easily tested by asking about the length of time spent in hospital. Person orientation includes name, age, and date of birth. Disorientation to one’s own name is
usually only seen in psychogenic amnesia.
The reason for using confrontation technique during a clinical interview is to
Select one:
1. Deal with difficult patients
2. Reveal some absurd notions that patients might hold
3. Make patients stop lying to the clinician
4. Help the patient face a difficult aspect of their problems.
5. Clarify certain associations that patients may not see
Help the patient face a difficult aspect of their problems.
Confrontation technique points out to a patient something to which the doctor thinks the patient is missing or denying. This must be done in a respectful way with an aim to help patients face a difficult aspect rather than dismissing patients by pointing out a negative aspect.
Which of the following cognitive domains is assessed by Wisconsin Card Sorting Test?
Select one:
1. Language
2. Visuospatial skills
3. Immediate recall
4. Retrieval
5. Planning and set shifting
Planning and set shifting
Executive functioning consists of volition, planning, purposive action, execution, error monitoring and error correction. These are cognitive control mechanisms managed by prefrontal areas of the brain.
Which of the following is a risk factor for QT prolongation on ECG?
Select one:
1. Hypokalaemia
2. Age 25 to 45
3. Male sex
4. Hypercalcemia
5. Tachycardia
Hypokalaemia
Risk factors for prolonged QT include organic heart disease, metabolic abnormalities such as hypokalaemia (by far the most common), hypocalcaemia, hypomagnesaemia, and bradycardia. A female preponderance may be caused by sex differences in specific cardiac ion densities.
Which of the following is not a test for executive function?
Select one:
1. Wisconsin Card Sorting Test
2. Line orientation test
3. Category Test
4. Trail Making Test
5. Stroop test
Line orientation test
Judging line orientation, Rey Osterrieth test and clock drawing are tests of visuospatial functioning.
Which of the following is NOT a component of clock drawing test?
Select one:
1. Using numbers 1 to 12 to create the face of a clock
2. Being aware of the current time when the test is administered
3. Indicating the hour correctly according to instructions
4. Indicating the minutes correctly according to instructions
5. Placing the hands of the clock correctly
Being aware of the current time when the test is administered
CDT (Clock Drawing Test) does not assess one’s orientation to time.
The correct answer is:
Which of the following is an advantage of open ended questions over closed questions?
Select one:
1. Answers to open questions are highly time-saving
2. Answers to open questions are doctor-directed
3. Answers to open questions are highly reliable
4. Answers to open questions are less precise
5. Answers to open questions are more informative
Answers to open questions are more informative
Open-ended questions yield highly informative answers. They produce spontaneous formulations, but the
answers are of low reliability, and are non-reproducible at a later date, or by a different doctor. They do not focus on target symptoms and so are not very time efficient.
The most appropriate description for executive function is
Select one:
1. The capacity to identify stimulus that induces a perception
2. The capacity of problem solving
3. The capacity of controlling emotion and impulse
4. The capacity of purposefully applying one’s physical skill
5. The capacity of accomplishing goal-directed behaviour
The capacity of accomplishing goal-directed behaviour
The generally accepted descriptions of executive function is that it is the capacity of purposefully applying one’s mental skills, or the capacity of accomplishing goal-directed behaviour.
A patient presents with sensory impairment over the contralateral face, arm, and leg involving pinprick, touch, vibration, position, two-point discrimination, and stereognosis. This patient is most likely to have a lesion in which of the following structures?
Select one:
1. Frontal lobe
2. Thalamocortical projections
3. Hippocampal region
4. Amygdalar nucleus
5. Occipital lesion
Thalamocortical projections
Thalamo-parietal projections, when damaged, can give rise to the above reported sensory disturbances in addition to disturbances in higher sensory integration resulting in failed 2 point discrimination and stereognosis.
Which of the following is NOT a good technique to use for a poor historian?
Select one:
1. Using verbal and nonverbal facilitation.
2. Collecting information in parts over multiple interviews.
3. Shifting to the neutral ground when necessary
4. Using open-ended questions
5. Using multiple choice questions
Using multiple choice questions
Use of open-ended questions and commands to increase the flow of information, use of continuation
techniques to keep the flow coming and shifting to the neutral ground when necessary are useful techniques for a poor historian.
Which of the following is a supportive technique not aimed at eliciting information?
Select one:
1. Clarification
2. Redirection
3. Validation
4. Interpretation
5. Symptom expectation
Validation
Validation helps to decrease a patient’s sense of embarrassment about a feeling or behaviour. Validation is often employed when quoting how it is normal for people to have different emotions/ reactions/ behaviours, etc.
In which of the following conditions do you expect to see a pulvinar sign on magnetic resonance imaging?
Select one:
1. Viral encephalitis
2. Lewy Body dementia
3. Amyloid angiopathy
4. Pick’s disease
5. Prion disease
Prion disease
The presence of regions of high signal intensity in the posterior thalamus on T2-weighted MR images is known as the ‘pulvinar’ sign. It is seen in 90% of patients with autopsy proven variant CJD.
In a motorbike accident, a 21-year-old driver sustains significant head injury. Following recovery from emergency neurological status, it is found that he has significant problems in error correction and categorization of objects. Which of the following is a likely area of lesion?
Select one:
1. Diencephalon
2. Parietal lobes
3. Frontal lobes
4. Occipital lobe
5. Temporal lobe
Frontal lobes
Categorization and error correction are tests for frontal lobe functioning.
Which of the following endocrine changes is noted in anorexia nervosa?
Select one:
1. Increased luteinising hormone levels
2. Decreased plasma cortisol levels
3. Low thyroxine T4 levels
4. Decreased carotene levels in plasma
5. Raised growth hormone levels
Raised growth hormone levels
In adolescents and adults with anorexia nervosa, increased basal growth hormone (GH) secretion, a higher number of secretory bursts, and higher GH concentration is seen. This can have adverse effects on bone mass and eventual growth curve.
A patient has normal accommodation reflex but no reaction on testing light reflex. What is the likely diagnosis?
Select one:
1. Marcus Gunn pupil
2. Argyll-Robertson pupil
3. Holmes Adie pupil
4. Hutchison pupil
5. Horner’s pupil
Argyll-Robertson pupil
In 1869, Douglas Argyll-Robertson described several patients whose pupils reacted poorly to light with a normal near response. Later the aetiology of this pupillary anomaly was discovered to be tertiary syphilis. Currently, diabetes leads the list of causes for the so called Argyll-Robertson Pupil or ARP.
Which one of the following techniques can measure the extent of myelination of white matter fibres at a macroscopic level?
Select one:
1. Resting state connectivity
2. Diffusion tensor imaging
3. Functional MRI
4. Single photon emission tomography
5. Arterial spin labelling
Diffusion tensor imaging
Diffusion tensor imaging (DTI) measures at the macroscopic level the extent of myelination of white matter fibres using fractional anisotropy, a measure of the degree and directionality of diffusion of water molecules. More recent advances in diffusion tensor imaging include deterministic and global probabilistic tractography, quantitative and more probabilistic measures respectively, of connectivity between reconstructed white
matter fibres.
