FMGE Psychiatry previous year questions

1. Q1. A young man with schizophrenia has gained 12 kg and developed dyslipidaemia on olanzapine. Which agent has the most favourable metabolic profile to switch to?

   • A. Clozapine
   • B. Paliperidone
   • C. Amisulpride
   • D. Ziprasidone

   Answer: D. Ziprasidone

2. Q2. A patient insists that an outside agency is moving his limbs and producing sensations in his body against his will. What is this first-rank symptom called?

   • A. Somatic passivity
   • B. Thought insertion
   • C. Delusion of reference
   • D. Depersonalisation

   Answer: A. Somatic passivity

1. Q1. A man avoids balconies and glass lifts and feels intense fear on looking down from a height, while recognising the fear as excessive. What is this?

   • A. Agoraphobia
   • B. Acrophobia
   • C. Vestibular vertigo
   • D. Panic disorder

   Answer: B. Acrophobia

2. Q2. A woman with a BMI of 27 describes eating very large quantities in a short time with a sense of loss of control, then self-inducing vomiting, several times a week for four months. She is preoccupied with her body shape. What is the diagnosis?

   • A. Binge eating disorder
   • B. Anorexia nervosa, binge-purge subtype
   • C. Bulimia nervosa
   • D. Avoidant restrictive food intake disorder

   Answer: C. Bulimia nervosa

1. Q1. A man stops his SSRI because of anorgasmia but remains depressed. Which antidepressant carries the lowest rate of sexual dysfunction, and how does it work?

   • A. Bupropion, a noradrenaline and dopamine reuptake inhibitor
   • B. Paroxetine, a selective serotonin reuptake inhibitor
   • C. Venlafaxine, a serotonin and noradrenaline reuptake inhibitor
   • D. Clomipramine, a tricyclic with strong serotonergic action

   Answer: A. Bupropion, a noradrenaline and dopamine reuptake inhibitor

2. Q2. A student is brought in an hour after smoking cannabis. Which combination of findings is most characteristic of acute intoxication?

   • A. Pinpoint pupils, bradycardia and respiratory depression
   • B. Dilated pupils, hypertension, hyperthermia and formication
   • C. Nystagmus, ataxia and slurred speech with a smell of solvent
   • D. Conjunctival injection, tachycardia, increased appetite and a dreamy altered sense of time

   Answer: D. Conjunctival injection, tachycardia, increased appetite and a dreamy altered sense of time

1. Q1. A heavy smoker wants to stop. Which pharmacological options have proven efficacy for cessation?

   • A. Mirtazapine alone
   • B. Bupropion and varenicline, either of which may be used
   • C. Fluoxetine alone
   • D. Clonidine as first-line monotherapy

   Answer: B. Bupropion and varenicline, either of which may be used

2. Q2. A woman on lithium becomes pregnant. Which malformation is classically associated with first-trimester exposure?

   • A. Neural tube defects
   • B. Ebstein anomaly of the tricuspid valve
   • C. Cleft lip and palate
   • D. Renal agenesis

   Answer: B. Ebstein anomaly of the tricuspid valve

1. Q1. Three days after his last drink, a man with alcohol dependence becomes disoriented and agitated, with coarse tremor, autonomic overactivity and vivid visual hallucinations of insects. What is this, and what is the treatment of choice?

   • A. Delirium tremens, treated with a long-acting benzodiazepine and thiamine
   • B. Wernicke encephalopathy, treated with glucose
   • C. Korsakoff psychosis, treated with antipsychotics
   • D. Alcoholic hallucinosis, treated with reassurance

   Answer: A. Delirium tremens, treated with a long-acting benzodiazepine and thiamine

2. Q2. A man of 43 is convinced, without any evidence, that his daughter intends to kill him. He is otherwise lucid, well-kempt, employed and has no hallucinations or thought disorder. What is the diagnosis?

   • A. Paranoid schizophrenia
   • B. Delusional disorder
   • C. Delirium
   • D. Obsessive-compulsive disorder

   Answer: B. Delusional disorder

1. Q1. A boy of normal intelligence reads and writes at age level but cannot master arithmetic despite a year of individual tuition. Under DSM-5, how is this classified?

   • A. Attention deficit hyperactivity disorder
   • B. Intellectual disability, mild
   • C. Specific learning disorder with impairment in mathematics
   • D. Autism spectrum disorder

   Answer: C. Specific learning disorder with impairment in mathematics

2. Q2. Seven hours after surgery a man with a history of regular drinking hears threatening voices but is fully oriented with stable observations and no tremor. What is the diagnosis, and what distinguishes it from delirium tremens?

   • A. Delirium tremens, distinguished by the hallucinations
   • B. Acute transient psychotic disorder, distinguished by the surgery
   • C. Alcoholic hallucinosis, distinguished by a clear sensorium and intact orientation
   • D. Post-operative delirium, distinguished by the timing

   Answer: C. Alcoholic hallucinosis, distinguished by a clear sensorium and intact orientation

1. Q1. A patient with alcohol dependence is admitted for elective surgery. Which regimen best prevents withdrawal complications?

   • A. Symptom-triggered benzodiazepine using a withdrawal scale, with parenteral thiamine given before any glucose load
   • B. Haloperidol alone, to control agitation
   • C. Intravenous glucose first, to correct hypoglycaemia
   • D. Abrupt abstinence with observation only

   Answer: A. Symptom-triggered benzodiazepine using a withdrawal scale, with parenteral thiamine given before any glucose load

2. Q2. A patient describes his mood as persistently low, while the examiner observes him smiling and animated throughout. Which terms describe what the patient reports and what the examiner observes?

   • A. Both are described as mood
   • B. Both are described as affect
   • C. Mood is what the patient reports; affect is what the examiner observes, and here they are incongruent
   • D. Affect is what the patient reports; mood is what the examiner observes

   Answer: C. Mood is what the patient reports; affect is what the examiner observes, and here they are incongruent

1. Q1. Six weeks after a road accident a man has intrusive flashbacks, avoids driving, and is hypervigilant and unable to work. What is the diagnosis, and what distinguishes it from the acute condition?

   • A. Acute stress disorder, since symptoms began immediately
   • B. Post-traumatic stress disorder, since symptoms have persisted beyond one month
   • C. Panic disorder, since the attacks are unexpected
   • D. Adjustment disorder, since there is an identifiable stressor

   Answer: B. Post-traumatic stress disorder, since symptoms have persisted beyond one month

2. Q2. The McNaughton rules on criminal responsibility for the mentally ill are reflected in which section of the Indian Penal Code?

   • A. Section 84
   • B. Section 85
   • C. Section 86
   • D. Section 87

   Answer: A. Section 84

1. Q1. A woman has repeated unexpected episodes of chest pain, palpitations and a fear of dying, peaking within ten minutes and settling in under half an hour, with normal investigations. What is the diagnosis?

   • A. Acute psychosis
   • B. Panic disorder
   • C. Post-traumatic stress disorder
   • D. Mania

   Answer: B. Panic disorder

2. Q2. Which of the following is NOT one of the stages described in the Kubler-Ross model of grief?

   • A. Denial
   • B. Anger
   • C. Bargaining
   • D. Agitation

   Answer: D. Agitation

1. Q1. Which intervention has NO role in the immediate management of an acutely violent psychiatric patient?

   • A. Oral or intramuscular benzodiazepine
   • B. Cognitive behavioural therapy
   • C. Intramuscular haloperidol
   • D. Electroconvulsive therapy in refractory catatonic excitement

   Answer: B. Cognitive behavioural therapy

2. Q2. What is meant by double depression?

   • A. A major depressive episode lasting more than two years
   • B. Major depression together with obsessive-compulsive disorder
   • C. A major depressive episode superimposed on pre-existing persistent depressive disorder (dysthymia)
   • D. Depression accompanied by panic attacks

   Answer: C. A major depressive episode superimposed on pre-existing persistent depressive disorder (dysthymia)

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.