Clinical Examination

Question 1

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

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

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

Answer 3

Contralateral spastic hemiplegia

Damage to upper motor neurons originating in frontal motor strip can result in contralateral spastic
hemiparesis.

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

Frontal cortex

Frontal brain dysfunction is notable in many unmedicated children with ADHD

Question 7

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

Answer 7

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.

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

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

Answer 11

Resting tremor

A resting tremor occurs with the body part in complete repose and often dampens or subsides entirely with action.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

Orientation to time

CDT (Clock Drawing Test) does not assess one’s orientation to time.

Question 14

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

Answer 14

Simultanagnosia

Simultanagnosia is characterized by the failure of an individual to perceive more than a single object at a time.

Question 15

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

Answer 15

Constructional praxis

Visuospatial ability, especially constructional praxis, is tested using intersecting polygons test.

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

3 days

Occasional use - up to 3 days. High daily use for long time - up to 4 weeks.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

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.

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

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.

Question 24

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

Answer 24

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.

Question 25

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

Answer 25

Metabolic alkalosis Loss of gastric acid can lead to metabolic alkalosis.

Question 26

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

Answer 26

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.

Question 27

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

Answer 27

Ankle clonus Cerebellar signs: Ataxia, hypotonia, dyssynergia (incoordination), dysmetria (past pointing), dysdiadochokinesis, dysrhythmia and dysarthria.

Question 28

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

Answer 28

PET scan PET involves using radionucleotides to study neuronal activity, neurochemistry and pharmacology of the brain.

Question 29

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

Answer 29

GABA-A receptors Iomazenil is used for GABA-A receptors.

Question 30

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

Answer 30

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.

Question 31

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.

Answer 31

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.

Question 32

The wavelet of EEG that is greater than 13Hz in frequency is Select one: 1. Delta 2. Beta 3. Theta 4. Gamma 5. Alpha

Answer 32

Beta Beta is the frequency range from 12 Hz to about 30 Hz.

Question 33

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

Answer 33

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.

Question 34

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

Answer 34

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.

Question 35

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

Answer 35

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.

Question 36

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

Answer 36

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.

Question 37

Inability to recognise familiar faces is seen in Select one: 1. Anosognosia 2. Simultanagnosia 3. Prosopognosia 4. Somatognosia 5. Visuospatial apraxia

Answer 37

Prosopognosia Prosopagnosia (face blindness) is a disorder of face perception where the ability to recognize faces is impaired.

Question 38

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

Answer 38

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).

Question 39

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

Answer 39

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.

Question 40

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

Answer 40

Sleep deprivation REM sleep during daytime can be seen in narcolepsy, sleep deprivation or withdrawal from stimulants.

Question 41

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

Answer 41

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.

Question 42

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

Answer 42

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'.

Question 43

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

Answer 43

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.

Question 44

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)

Answer 44

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).

Question 45

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

Answer 45

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.

Question 46

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

Answer 46

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.

Question 47

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

Answer 47

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.

Question 48

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

Answer 48

Arterial spin labelling Arterial spin labelling is a non-invasive perfusion MRI methodology used to quantify cerebral blood flow.

Question 49

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

Answer 49

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).

Question 50

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

Answer 50

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.

Question 51

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

Answer 51

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.

Question 52

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

Answer 52

Calcified lesions are better visualised The only component of the brain better seen on CT scanning is calcification, which may be invisible on MRI.

Question 53

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

Answer 53

Eight 5 points are awarded for orientation in time and 3 points for recall.

Question 54

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

Answer 54

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.

Question 55

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

Answer 55

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.

Question 56

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

Answer 56

48 hours Amphetamines, codeine and morphine could be detected in urine for up to 48 hours.

Question 57

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

Answer 57

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.

Question 58

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

Answer 58

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.

Question 59

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

Answer 59

Copying Reading, writing, repetition, fluency, comprehension and naming are tested to localize aphasia.

Question 60

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

Answer 60

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.

Question 61

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

Answer 61

Non-fluent aphasia In Broca's aphasia, due to damage to the motor speech zone, the language appears non-fluent.

Question 62

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

Answer 62

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.

Question 63

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

Answer 63

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.

Question 64

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

Answer 64

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

Question 65

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

Answer 65

Haemorrhage Blood appears bright in CT and T1 MRI.

Question 66

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

Answer 66

Statement of respect Affirmative statements that are genuine and appropriate indicating respect and dignity offer positive reinforcement during a psychiatric interview.

Question 67

The most common opportunistic infection in a patient with AIDS is Select one: 1. Leprosy 2. Toxoplasma 3. Cytomegalo virus 4. Cryptococcus 5. Syphilis

Answer 67

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.

Question 68

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

Answer 68

Muscular atrophy Atrophy is seen in LMN lesions, not in UMN lesions.

Question 69

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?

Answer 69

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.

Question 70

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

Answer 70

Lexical fluency Lexical fluency is a frontal lobe test, whereas Stereognosis, finger agnosia, Right left orientation, two point discrimination are tests for parietal lobe.

Question 71

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

Answer 71

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.

Question 72

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

Answer 72

HIV illness Generalised lymph node enlargement with muscle wasting along with social withdrawal (possibly due to perceived stigma) is suggestive of a HIV illness.

Question 73

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

Answer 73

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.

Question 74

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

Answer 74

Reinforcement Reinforcement aids in further disclosure and continuation of a diagnostic interview.

Question 75

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

Answer 75

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.

Question 76

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

Answer 76

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.

Question 77

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

Answer 77

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.

Question 78

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

Answer 78

Ophthalmoplegia Ophthalmoplegia responds within hours, but cognitive impairment takes longer.

Question 79

Copying intersecting polygons in MMSE tests the functions of Select one: 1. Hippocampus 2. Parietal lobes 3. Temporal lobes 4. Cerebellum 5. Frontal lobes

Answer 79

Parietal lobes Visuospatial ability is a function of parietal lobes.

Question 80

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

Answer 80

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.

Question 81

Wernicke's encephalopathy is directly caused by a deficiency of Select one: 1. Thiamine 2. Alcohol dehydrogenase 3. Riboflavin 4. Niacin 5. Aldehyde

Answer 81

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.

Question 82

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

Answer 82

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.

Question 83

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

Answer 83

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.

Question 84

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

Answer 84

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.

Question 85

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

Answer 85

Primary motor cortex The region of the brain that is often highlighted by functional MRI scan is the primary motor cortex.

Question 86

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

Answer 86

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.

Question 87

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

Answer 87

Lesions of optic tract Confrontation test is used to assess the central visual field by using a red pin.

Question 88

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?

Answer 88

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.

Question 89

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

Answer 89

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.

Question 90

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

Answer 90

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:

Question 91

Clinical features of drug-induced hyponatraemia include Select one: 1. Muscle cramps 2. Constipation 3. Diarrhoea 4. Tremors 5. Sweating

Answer 91

Muscle cramps Signs and symptoms of hyponatremia include nausea and vomiting, headache, confusion, lethargy, fatigue, appetite loss, muscle cramps and restlessness with irritability.

Question 92

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

Answer 92

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:

Question 93

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

Answer 93

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.

Question 94

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

Answer 94

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.

Question 95

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

Answer 95

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.

Question 96

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

Answer 96

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.

Question 97

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

Answer 97

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.

Question 98

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

Answer 98

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.

Question 99

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

Answer 99

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.

Question 100

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

Answer 100

Line orientation test Judging line orientation, Rey Osterrieth test and clock drawing are tests of visuospatial functioning.

Question 101

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

Answer 101

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:

Question 102

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

Answer 102

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.

Question 103

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

Answer 103

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.

Question 104

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

Answer 104

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.

Question 105

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

Answer 105

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.

Question 106

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

Answer 106

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.

Question 107

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

Answer 107

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.

Question 108

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

Answer 108

Frontal lobes Categorization and error correction are tests for frontal lobe functioning.

Question 109

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

Answer 109

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.

Question 110

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

Answer 110

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.

Question 111

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

Answer 111

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.