Download MCQ exam (Paper 2): Answer Key 1. Which of the following is the

MCQ exam (Paper 2): Answer Key
History, mental state exam and psychopathology
1. Which of the following is the BEST example of
inattention?
A. The patient interrupts the conversation to ask
when he will be discharged.
B. The patient is oriented and aware of his recent
medical problems but falls asleep during the
conversation.
C. The patient suddenly bursts into tears when you
are discussing his recent amputation.
D. The patient watches a fly buzzing on the ceiling
while you are discussing the prognosis for his lung
cancer, then falls asleep.
E. The patient cannot remember what you have told
him 3 minutes ago. Then he tries to make up the
answer.
The best answer is D.
A. Impulsive interruptions may
or may not indicate
inattentiveness.
B. Falling asleep may indicate
inattentiveness, but further
information would be needed
to rule out other explanations
such as recent administration
of a sedating medication.
C. Sudden bursts of affect have a
significant differential beyond
inattention.
D. This patient seems distracted
despite discussion of an issue
of vital personal importance
to him. In the context also of
apparent drowsiness, the
clinician should suspect the
presence of delirium.
E. The patient may suffer from
dementia and cannot register
the information.
Author: Roger Ho
2. A 30-year-old man firmly believes that the alien
has put an implant in his body and he feels there
is a pushing sensation on his aorta. Which types of
hallucinations BEST suited his description?
A.
B.
C.
D.
E.
Auditory
Cenesthetic
Gustatory
Kinesthetic
Visual.
Year: 2013.
The answer is B.
Explanation: Cenesthetic
hallucinations are unfounded
sensations of altered states in bodily
organs. Examples of cenesthetic
hallucinations are a burning sensation
in the brain, a pushing sensation in
the blood vessels, and a cutting
sensation in the bone marrow. Bodily
distortion may also occur.
Author: Roger Ho
Year: 2013.
This is an advanced-level question.
3. Perseveration is MOST commonly seen in which of
the following disorders?
A. Autism
The answer is D.
Explanation: Perseveration is a
persisting response to a previous
B.
C.
D.
E.
Attention deficit and hyperactivity disorder
Bipolar disorder
Frontal lobe dementia
Obsessive compulsive disorder.
stimulus after a new stimulus has
been presented; it is often associated
with frontal lobe lesion.
Author: Roger Ho
Year: 2013
4. A patient presents with persistence,
perfectionism and body image distortion. Which
of the following disorders is MOST likely to be
associated with the above clinical features?
A.
B.
C.
D.
E.
Anorexia nervosa
Borderline personality disorder
Delusional disorder
Hypochondriasis
Somatization disorder.
The answer is A.
Explanation: Persistence and
perfectionism are associated with
obsessive-compulsive personality
traits and disorders, along with body
image distortion occurring in many
patients with anorexia nervosa.
Author: Roger Ho
Year: 2013
Cognitive assessment
5. Which of the following statement is FALSE
about Mini-mental state examination (MMSE)?
A. A total score of 5 indicates severe dementia.
B. Assessment of orientation to time and place is part
of the MMSE.
C. The MMSE can be administered in Chinese or
English.
D. The MMSE can be used to monitor treatment
progress after initiation of acetylcholinesterase
inhibitors (AChEIs).
E. The MMSE is the gold standard in establishing the
diagnosis of dementia.
The answer is E.
Explanation: MMSE is a screening test
and there is no gold standard to
establish the diagnosis of dementia in
clinical practice. Clinical assessment
by a psychiatrist or geriatrician is
more important than MMSE in
establishing diagnosis of dementia.
Author: Roger Ho
Year: 2013
Psychiatric epidemiology
6. Which of the following settings have the HIGHEST
prevalence of delirium?
A.
B.
C.
D.
E.
Accident and emergency department
Cardiac surgery ward
General surgery ward
Hospice with palliative advanced cancer patients
Nursing home looking after dementia patients.
The answer is D.
Explanation: General surgical patients:
10-15%; Cardiac surgery patients:
30%; Hip fractures: 50%; Age >65
admitted to ICU: 70%; Palliative
advanced cancer patients: 88%.
Author: Roger Ho
7. The worldwide point prevalence of
schizophrenia is BEST estimated as:
A. 1%
Year: 2013.
The answer is A.
Explanation: The worldwide point
prevalence is 1% and Singapore is
B.
C.
D.
E.
2.5%
5%
7.5%
10%.
0.6%.
Author: Roger Ho
Year: 2013
Psychiatric aetiology, diagnosis and classification
8. Advanced paternal age is a well- established
risk factor for which of the following psychiatry
illnesses?
A.
B.
C.
D.
E.
Alcoholism
Major depressive disorder
Obsessive compulsive disorder
Generalized anxiety disorder
Schizophrenia.
9. Which of the following social factors is
MOST LIKELY to be associated with relapse
of schizophrenia after hospitalization?
A. Discrimination
B. Financial problems
C. Homelessness
D. Increased expressed emotion
E. Isolation and absence of family
member.
The answer is E.
Explanation: Advanced paternal age is
a risk factor for schizophrenia.
Author: Roger Ho
Year: 2013.
The answer is D.
High levels of expressed emotion
(EE) in the families of patients with
schizophrenia predicted relapse
following hospital discharge.
Psychoeducational family therapy
aims at helping the family reduce
the factors that constitute
expressed emotion. The therapist
also educates the family about
schizophrenia and the need to
continue antipsychotic medication
indefinitely.
Author: Roger Ho
10. Individuals with which one of the following genes
have the HIGHEST risk of developing Alzheimer’s
disease?
A.
B.
C.
D.
E.
Homozygous apolipoproteins (APO) E2/E2
Homozygous APO E4/E4
Homozygous APO E6/E6
Heterozygous APO E2/E4
Heterozygous APO E2/E6.
Year: 2013.
The answer is B.
Explanation: Homozygous APO E4/E4
increases the risk of developing
Alzhimer’s disease by 8 times.
Author: Roger Ho
Year: 2013.
General adult psychiatry
11. A 40-year-old man suffered from a heart attack
under general anaesthesia. The doctors in the
operation theatre successfully resuscitated him.
After recovery, he wants to sue the hospital for
causing him post-traumatic stress disorder (PTSD).
He claims the resuscitation process was
extremely traumatic. Which of the following is the
MOST IMPORTANT feature to exclude the
The answer is D.
Explanation: In the new diagnostic
criteria, it is possible for a PTSD
patient not to directly witness a
traumatic event and learn about it
from others after the accident. The
most crucial feature is whether
diagnosis of PTSD?
A. He does not have past history of PTSD.
B. He has hidden agenda of suing the hospital
and tries to seek compensation.
C. He was under general anaesthesia and he was
not conscious during resuscitation.
D. The process of resuscitation is not considered
to be traumatic in general and doctor
resuscitated him in his best interest.
E. He did not seek treatment from a psychiatrist
after the operation.
12. Common symptoms of panic attacks include the
all of following EXCEPT:
A.
B.
C.
D.
E.
Fear of dying
Fear of losing control
Fear of going crazy
Palpitations
Suicidal thoughts.
13. Which of the following schizophrenia patients
has the HIGHEST suicide risk?
A. An adolescent with prodromal symptoms and vague
paranoid idea.
B. An elderly retired man with late onset schizophrenia.
C. A middle-aged man with negative symptoms.
D. A middle-aged woman who suffers from simple
schizophrenia.
E. A young male university student who once had high
expectations.
14. Which of the following is NOT a recognized
alteration of sleep disturbance associated with
major depressive disorder?
A. Difficulty in falling asleep
B. Increase in nocturnal awakening
C. Increase in density of Rapid Eye Movement (REM)
sleep
D. Increase in the latency of Rapid Eye Movement
(REM) sleep
E. Reduction of total sleep time.
15. A 40-year-old woman is staying with her godbrother. She was rejected by her family and she
felt helpless in the past. She needs her godbrother to make decision for her and her godbrother asks her to be the housekeeper in
return. One day, her god-brother needs to go to
Vietnam for 1 week and she feels extremely
uncomfortable. Which of the following
resuscitation itself is not a traumatic
process and it is necessary for doctors
to save patients’ life by resuscitation.
Author: Roger Ho
Year: 2013
This is an advanced – level question.
The answer is E.
Explanation: Suicidal thought is not
common symptom of panic attack.
Author: Rathi Mahendran
Year: 2013.
The answer is E.
Explanation: The profile of the patient
at greatest risk is a young man who
once had high expectations, declined
from a higher level of functioning,
realizes that his dreams are not likely
to come true, and has lost faith in the
effectiveness of treatment.
Author: Roger Ho
Year: 2013.
The answer is D.
Explanation: It should be reduction of
latency of REM sleep.
Author: Roger Ho
Year: 2013.
This is an advanced level question.
The answer is B.
Explanation: She is best described to
suffer from dependent personality
because she cannot make decision on
her own, uncomfortable when left
alone and subordination to her god-
personality traits BEST describes this person?
A.
B.
C.
D.
E.
Borderline personality
Dependent personality
Histrionic personality
Schizoid personality
Schizotypal personality.
brother’s need (e.g. to be a
housekeeper).
Author: Roger Ho
Year: 2013
16. A 30-year-old man comes to see you and he
worries about premature ejaculation. The MOST
appropriate time frame to meet the diagnosis of
premature ejaculation is:
A. Ejaculation occurs within 60 seconds following
vaginal penetration.
B. Ejaculation occurs within 90 seconds following
vaginal penetration.
C. Ejaculation occurs within 120 seconds following
vaginal penetration.
D. Ejaculation occurs within 150 seconds following
vaginal penetration.
E. Ejaculation occurs within 180 seconds following
vaginal penetration.
The answer is A.
17. A 30-year-old man suffered from eight episodes of
The answer is D.
mood disturbances within a single year. These
mood episodes met the diagnostic criteria for
major depression, mania and hypomania. These
episodes were separated by remission. Which of
the following is the MOST likely diagnosis?
A.
B.
C.
D.
E.
Cyclothymic disorder
Emotionally unstable personality disorder
Mixed affective disorder
Rapid cycling bipolar disorder
Schizoaffective disorder.
Explanation: Premature ejaculation is
defined as ejaculation occurs within
60 second following vaginal
penetration and the patient wishes it.
Author: Roger Ho
Year: 2013
Explanation: This patient has more
than 4 episodes of mania and
depressive disorder in 1 year. He is
too severe for cyclothymic disorder.
Author: Roger Ho
Year: 2013
Old age psychiatry
18. Which of the following is NOT a predisposing
The answer is D.
factor for depression in the elderly?
A.
B.
C.
D.
E.
Cerebrovascular accident
Poly-pharmacy
Looking after a spouse with chronic illness
Male gender
Widowhood.
Explanation: Women have longer life
span compared to men. As a result,
women are more likely to be a widow
and correspond to option E.
Author: Roger Ho
Year: 2013.
19. Dementia in general is BEST described as:
The answer is E.
A. Behavioural disturbance
B. Global impairment
C. Impaired memory for personal events (e.g.
marriage, past occupation)
D. Personality change
Explanation: dementia is a progressive
deterioration of cognition, including
memory and/or one of four other
cognitive symptoms (aphasia, apraxia,
agnosia,
impaired
executive
E. Progressive deterioration.
functioning) but it may not be a global
impairment. Impairment memory for
recent events is more common than
personal events.
Author: Roger Ho
20.
A 65-year-old man presents with memory
loss, which of the following is the LEAST important
indication for a computerized tomography (CT)
scan for his brain:
Year: 2013.
The answer is C.
Explanation: The other factors
suggest an organic cause.
A. A sudden decrease in cognitive function over a onemonth period
B. Gait abnormalities
C. His age
D. Urinary incontinence
E. Use of anticoagulants.
Author: Roger Ho
21. For anxiety disorders in the elderly, which of the
The answer is D
Year: 2013.
following statements is TRUE?
A. Prevalence increases with age.
B. Prevalence rates are lower in women.
C. Common primary diagnoses in hospital population.
D. Highest rates are found in the community.
E. Most anxiety disorders have onset in late life.
Explanation: Majority of anxiety
disorders in elderly has their onset in
young adult and middle age and are
mainly managed by primary
healthcare providers in the
community. In the hospital setting,
are usually comorbid conditions and
are uncommonly primary diagnoses in
the hospital population.
Author: Tan Lay Ling
Date of submission: 27 Feb 2013
This is an advanced-level question
Child and adolescent psychiatry
22. Which of the following is THE MOST IMPORTANT
predictor of bipolar disorder in adolescent
depression?
A.
B.
C.
D.
E.
Diurnal variation of mood
Hypomanic symptoms after taking antidepressants
Hypersomnia
Increased weight
Multiple suicide attempts.
23. The MOST COMMON reason for children with
autism are brought to medical attention by their
parents is:
The answer is B.
Explanation: Antidepressant is the
most common cause of hypomania
and hypomania is part of the bipolar
disorder.
Author: Roger Ho
Year: 2013.
The answer is A.
Explanation: Language delay is the
most obvious sign and most disturbing
A.
B.
C.
D.
E.
Language delays
Lack of toilet control
Odd play
School difficulties
Stereotyped behaviour.
to parents when they discover their
children are lacking behind in
language development compared to
other children.
Author: Roger Ho
24. Which of the following statements is FALSE
regarding separation anxiety disorder?
A. It involves recurrent distress when separate from
attachment figures.
B. Separation anxiety disorder does not occur in
adolescents.
C. Separation anxiety disorder is associated with school
refusal.
D. The child has difficulty falling asleep at night.
E. The child may complain of somatic symptoms.
25. Which of the following symptoms is MOST
LIKELY to persist when a young person suffers
from Attention Deficit and Hyperactivity
Disorder (ADHD) becoming an adult?
A.
B.
C.
D.
E.
Accident risk
Hyperactivity
Impulsivity
Inattention
Learning difficulties.
Year: 2013.
The answer is B.
Explanation: Separation anxiety disorder
is more common in children and it can
occur in adolescents.
Author: Roger Ho
Year: 2013.
The answer is D.
Answer: Although symptoms of
hyperactivity and impulsivity often
improve as the child grows older,
inattentive symptoms are likely to
persist.
Author: Roger Ho
26. A baby is born with low birth weight, microcephaly,
small eyes, upturned nose and a smooth, undeveloped
philtrum. He fails to thrive and develops seizures.
Which of the following was he MOST likely exposed
to during pregnancy?
A. Alcohol
B. Cocaine
C. LSD
D. Methamphetamine
E. Inhalants.
Year: 2013
The answer is A.
Explanation: This is a classical
description of the facial features of
foetal alcohol syndrome
Author: Roger Ho
Year: 2013.
Substance abuse
27. The term which BEST describes an altered
physiological state and neuro- adaptation caused
by repeated administration of a drug is:
A.
B.
C.
D.
E.
Addiction
Dependence
Misuse
Withdrawal
Tolerance.
The answer is B.
Explanation: The term dependence
indicates physiological changes.
Misuse refers to use of any drug,
usually by self-administration, in a
manner that deviates from approved
social or medical patterns. Addiction is
non-specific and ignores the concept
of substance dependence is a medical
condition.
Author: Roger Ho
28. While driving, a 40-year-old man with no previous
history refused to stop for the traffic police. He
was subsequently brought into the accident and
emergency department (AED) by them. You are
the resident working in the AED. When you assess
him, he states that he was hearing voices in clear
consciousness. He admits to a history of alcohol
use. What is the most appropriate diagnosis?
A.
B.
C.
D.
E.
Alcoholic hallucinosis
Delirium tremens
Korsakoff psychosis
Schizophrenia
Wernicke’s encephalopathy.
29. Which of the following BEST describes the
mechanism of action with naltrexone in the treatment
of alcohol dependence?
A. Naltrexone acts on the benzodiazepine receptor and
prevents alcohol withdrawal.
B. Naltrexone blocks opioid receptors to decrease alcohol
craving.
C. Naltrexone inhibits aldehyde dehydrogenase to decrease
alcohol craving.
D. Naltrexone is a GABA agonist and decreases alcohol
craving.
E. Naltrexone is a glutamate antagonist and decreases
alcohol craving.
30. Which of the following complications is LEAST
likely to occur in cocaine abusers?
A. Arrhythmia
B. Hyperthermia
C. Myocardial infarction
D. Phlebitis
E. Seizure.
Year: 2013.
The answer is A.
Explanation: Auditory hallucinosis is
usually composed of auditory
hallucination. Sensorium is clear and it
is different from delirium tremens.
There are not enough symptoms to
conclude that he suffers from
schizophrenia.
Author: Roger Ho
Year: 2013.
The answer is B.
Explanation: Option A refers to
benzodiazepine. Option C refers to
the action of disulfiram. Option D and
E refer to the action of acamprosate.
Author: Roger Ho
Year: 2013.
The answer is D.
Explanation: Cocaine is least likely to
be injected via IV route. As a result,
phlebitis is relatively less likely to
occur in patients misusing cocaine.
Author: Roger Ho
Year: 2013
This is an advanced-level question.
31. The primary neurotransmitter involved with
Lysergic acid diethylamide (LSD) is:
a. Acetylcholine
b. Dopamine
c. γ-Aminobutyric acid
d. Norepinephrine
The answer is E.
Explanation: LSD increases the level of
serotonin and overdose of LSD is
associated with serotonin syndrome.
e. Serotonin.
Author Roger Ho
Year: 2013.
32. All of the following are true about alcohol
A.
B.
C.
D.
E.
withdrawal EXCEPT:
Central nervous system hyperexcitability
Onset 12 to 24 hours after last drink
Peak intensity at 24 to 48 hours
Sympathetic hypoactivity
Triggered by abrupt cessation of intake in
dependent persons.
Psychopharmacology
33. Monoamine oxidase inhibitor (MAOI) is LEAST
useful in treating which of the following
disorders?
A.
B.
C.
D.
Atypical depression
Obsessive compulsive disorder
Panic disorder
Severe depressive disorder not responding to
selective serotonin reuptake inhibitor
E. Severe depressive disorder with hyponatraemia
The answer is D.
Explanation: It should be sympathetic
hyperactivity.
Author: Rathi Mahendran
Year: 2013.
The answer is B.
Explanation: MAOI is least useful to
treat OCD.
Author: Roger Ho
Year: 2013.
This is an advanced-level question.
34. Which of the following antidepressants is LEAST The answer is A.
likely to contribute to the development of
serotonin syndrome?
Explanation: Bupoprion works on
dopamine and norepinephrine. As a
A. Bupropion
result, it is least likely to cause
B. Fluoxetine
serotonin syndrome.
C. Moclobemide
D. Paroxetine
Answer: Roger Ho
E. Venlafaxine.
Year: 2013.
This is an advanced-level question.
35. Which of the following antipsychotics exhibit a
novel mechanism as a partial antagonist?
A.
B.
C.
D.
E.
Aripiprazole
Clozapine
Olanzapine
Quetiapine
Ziprasidone.
The answer is A.
Explanation: Aripiprazole exhibits a
novel mechanism by definition while
other antipsychotics listed do not
have this property.
Author: Roger Ho
Year: 2013.
36. Regarding lamotrigine, which of the following The answer is C.
statements is FALSE?
A. It acts at voltage-sensitive sodium channels.
Explanation: Double-blind, placebo-
B. It inhibits the release of excitatory amino acid
neurotransmitters.
C. It is not effective in the treatment of bipolar
depression.
D. Its use can lead to toxic epidermal necrolysis.
E. There is no need to monitor lamotrigine blood
levels during treatment.
controlled trials have shown that it
has acute and prophylactic antidepressant effects. It can lead to
severe dermatological condition such
as Steven Johnson syndrome/ toxic
epidermal necrolysis. In Singapore,
there is no blood test to check its
level.
Author: Roger Ho
Year: 2013
This is an advanced-level question.
37. Anticholinergic side effects include all of
The answer is A.
the following EXCEPT:
A.
B.
C.
D.
E.
Bradycardia
Constipation
Dry mouth
Exacerbation of open-angle glaucoma
Urinary retention.
38. In a schizophrenia patient without history of
asthma, the BEST treatment for chronic
akathisia is:
A.
B.
C.
D.
E.
Alprazolam
Benzhexol
Clonazepam
Propranolol
Vitamin E.
Explanation: Anticholinergic side
effect include tachycardia.
Author: Roger Ho
Year: 2013.
The answer is D.
Explanation: Propranolol (beta
blocker) is the best treatment in this
patient without history of asthma as it
does not cause dependence as in
Option A and C. Beta blockers can
reduce restlessness and tremor.
Option B is more useful for
pseudoparkinsonism.
Author: Roger Ho
39. Which
of
the
following
psychotropic
medications is MOST EFFECTIVE in preventing
relapse in rapid cycling bipolar disorder?
A.
B.
C.
D.
E.
Haloperidol
Lithium
Olanzapine
Valproate
Risperidone.
Year: 2013.
The answer is D.
Explanation: Lithium is less effective in
preventing relapse in rapid cycling
bipolar disorder. Valproate and
carbamazepine are preferred over
lithium.
Author: Roger Ho
2013
40. Common side-effects of clozapine include the The answer is E.
following EXCEPT:
A.
B.
C.
D.
E.
41.
A.
B.
C.
D.
E.
Explanation: Clozapine and olanzapine
are well-known in causing weight gain
and metabolic syndrome.
Anticholinergic side-effects
Agranulocytosis
Sedation
Seizures
Weight loss.
Author: Rathi Mahendran
Modified by Roger Ho
2013
Common indications for ECT include all of the The answer is E.
following EXCEPT:
Contraindications to medication
Explanation: Strong suicide ideation
Medication failure
rather than repeated self-harm is a
Previous good response
common indication for ECT.
Psychotic depression
Repeated self-harm.
Author: Rathi Mahendran
2013
Psychotherapy
42. In conducting psychotherapy with individuals who
have experienced a traumatic event and suffer
from post-traumatic stress disorder (PTSD), the
following are all recommended techniques
EXCEPT:
The answer is A.
A.
B.
C.
D.
E.
Encouraging avoidance of emotion
Examining feelings of guilt
Examining the patient’s response to the trauma
Offering consolation
Overcoming avoidance or phobia related to the
trauma.
Author: Roger Ho
43. A 30-year-old woman with panic disorder does
not respond to an initial treatment with an
selective serotonin reuptake inhibitor (SSRI).
Which of the following treatment is considered
the best approach?
The answer is B.
A.
B.
C.
D.
E.
Year 2013.
Explanation: The effect of CBT is as
efficacious as SSRI.
Author: Roger Ho
Benzodiazepine
Cognitive behaviour therapy
Serotonin-noradrenaline reuptake inhibitor
Olanzapine
Psychodynamic psychotherapy.
44. Which of the following statements
INCORRECT about Interpersonal therapy?
Explanation: A is the answer. Affect or
emotion should not be avoided in
psychotherapy.
Year: 2013.
is
A. Has been shown to be efficacious in adult outpatients
suffering from depression.
B. Is more efficacious than psychodynamic psychotherapy
C. Works as quickly as antidepressant medication.
D. Works best in mild to moderate depression.
E. Works best in people facing problems in role transition.
The answer is C.
Explanation: Interpersonal therapy is
slower than the effect of
antidepressant because the therapist
needs time to assess the patient and
formulate strategies (e.g.
interpersonal inventory and role play).
Author: Roger Ho
45. A 23-year-old student is seen in the University
counselling centre because of relationship
problems. She has had one serious relationship
with her boyfriend that lasted about six months.
She terminated the relationship because she
discovered that her boyfriend was seeing
someone else.
During psychotherapy, she
mentions that ‘All men just can’t be trusted.’
Which of the following BEST describes this
thinking error?
Year: 2013.
The answer is D.
Explanation: This patient
demonstrates overgenearlization
because she believes in and follows a
general rule on the basis of limited
examples.
Author: Roger Ho
Year: 2013.
A.
B.
C.
D.
E.
Arbitrary inference
Dichotomous thinking
Magnification
Overgeneralization
Selective abstraction.
Ethics and laws
46. All medical students are required to study
psychiatry so that they are qualified to assess and
manage common psychiatric disorders after
graduation. The compulsory psychiatric training is
BEST described by which of the following ethical
principles?
A.
B.
C.
D.
E.
Autonomy
Beneficence
Morality
Justice
Fiduciary duty.
The answer is B.
Explanation: With competent
psychiatric knowledge, the future
doctors can provide benefits to
patients when making decision on
diagnosis and management. The other
concept that is relevant is dereliction.
Fiduciary duty refers to the duty that
the doctor must act in the patient’s
best interest and it is not as relevant
as beneficence in this case.
Author: Roger Ho
Year: 2013
Liaison and neuropsychiatry
47. You are a medical resident. A 40-year-old The answer is B.
schizophrenia patient was admitted as a result of
polydipsia. Which of the following statements Explanation: Psychogenic polydispsia
regarding polydipsia in schizophrenia is NOT true? is a common condition for chronic
schizophrenia. The estimates of
A. It is associated with low urine osmolality.
prevalence range from 5 to 20%. The
B. It is associated with high sodium in urine.
patient drinks excess water and
C. It is associated with low serum sodium.
results in diluted urine. The body tries
D. Patients should be investigated for Syndrome of
to preserve sodium and results in low
Inappropriate Secretion of Anti-Diuretic Hormone
urine sodium. The serum is diluted.
(SIADH).
SIADH should be considered for DDX.
E. Polydipsia occurs in between 5 to 20% of patients
suffering from chronic schizophrenia.
Author: Roger Ho
Year: 2013.
This is an advanced-level question.
48. A 40-year-old British man is admitted to the The answer is B.
medical ward. He tries to run away from the ward.
He is very aggressive and the security guards have Explanation: He suffers from delirium
difficulty to stop him. He claims that he is tremens. Intramuscular diazepam has
currently working in the office. The medical poor absorption. Option C and D are
records show that he has been drinking half of a not available in Singapore. Option E is
bottle of whisky every night. You need to order a a depot antipsychotics and it is not
medication to sedate him. He refuses to take any useful in acute setting.
oral medication.
Which of the following
medications is the BEST alternative in Singapore?
Author: Roger Ho
A.
B.
C.
D.
E.
Intramuscular diazepam
Intramuscular lorazepam
Intramuscular olanzapine
Intramuscular quetiapine
Intramuscular risperidone.
Year: 2013
49. You are the resident working for the liver The answer is B.
transplant team. The MOST common psychiatric
disorder in patients with liver cancer in the week Explanation: Delirium is the most
before and after transplantation is:
common disorder and it can be
caused by systemic infection, side
A. Adjustment disorder
effect of immunosuppressant,
B. Delirium
impairment of liver function, hepatic
C. Generalized anxiety disorder
encephalopathy.
D. Major depressive disorder
E. Somatoform pain disorder.
Author: Roger Ho
Year: 2013.
50. You are the resident working in the obstetrics The answer is B.
department. Which of the following is the BEST
treatment strategies to treat hyperemesis during Explanation: Benzodiazepine may
pregnancy?
cause cleft palate in the first
trimester. Psychoanalysis is not for
A. Benzodiazepines e.g. alprazolam
symptomatic relief. SSRI like
B. Relaxation therapy
fluvoxamine is associated with nausea
C. Psychoanalysis
side effect. Hyperemesis is not
D. Selective serotonin reuptake inhibitor e.g. associated with stimulus. Relaxation
fluvoxamine
therapy is the best treatment.
E. Stimulus deprivation.
Author: Roger Ho
Year: 2013.
Vetted by: Dr. Lai YM (2013)