Metabolic and Biochemical Disturbances in Psychiatry

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1. Regarding hyperthyroidism:  
A. It is more common in men
F
B. It usually presents in old age
F
C. A ‘thyroid storm’ is seen in 3-5 % of all patients
T
D. Depression is more common than mania
F
E. Schizophrenic psychoses are more common than mania
T
   
2. Regarding hypothyroidism:  
A. More common in women
T
B. It usually presents in the 3rd or 4th decade
F
C. Auditory hallucinations may be present
T
D. EEG changes are seen in a third of patients
T
E. Prognosis is poorer if the presentation has an organic quality
F
   
3. Cushing’s syndrome:  
A. Is more common in women
T
B. Usually presents in the 3rd or 4th decade
T
C. Only a few cases have psychiatric symptoms
F
D. Mania is more common than depression
F
E. Psychoses are usually depressive
T
   
4. Steroid drug treatment:  
A. Is more commonly associated with depression
F
B. Symptoms occur after 2-3 months
F
C. The mental disturbance is related to the dose of the steroids
F
D. Those with past mental illness are more likely to suffer psychiatric symptoms
F
E. Females are more prone
T
   
5. Adrenocortical deficiency:  
A. Has equal sex prevalence
F
B. May be caused by tuberculosis
T
C. Fatigue, weakness, and apathy are the common symptoms
T
D. Psychosis is common
F
E. Both glucocorticoids and mineralocorticoids are needed to reverse the mental symptoms
F
   
6. Regarding hyperparathyroidism:  
A. It is seen only in MEN type I syndrome
F
B. Psychiatric symptoms are due to the effects of elevated PTH levels
F
C. Depression is the most common psychiatric condition
T
D. The EEG shows widespread slow wave activity
T
E. Rebound psychosis may occur in the first week after treatment
T
   
7. In hypoparathyroidism:  
A. Most patients are female
T
B. Psychiatric features are seen rarely in idiopathic cases
F
C. Secondary hypoparathyroidism commonly presents as an acute confusional state
T
D. Secondary hypoparathyroidism is suspected if there is symmetrical calcification in the basal ganglia
F
E. Generalized seizures may occur
T
   
8. Regarding pituitary disease:  
A. Psychosis is common in acromegaly
F
B. Libido is increased in acromegaly
F
C. The prevailing mood in hypopituitarism is depression
T
D. Apathy and anergia are common in hypopituitarism
T
E. Symptoms of hypopituitarism will fully resolve with treatment
F
   
9. In diabetes mellitus:  
A. MAOIs may potentiate the effects of oral hypoglycaemic agents
T
B. In ketoacidotic coma, the level of consciousness correlates with plasma osmolality
T
C. Hyperosmolar non-ketotic coma is common in the elderly
T
D. There is a negative correlation between emotional upset and good diabetic control
T
E. Dementia is less common
F
   
10. Diabetes inspidus, insulinoma, and phaeochromcytoma:  
A. 10 % of beta-cell tumours are malignant
T
B. Insulinoma is commonest in childhood and old age
F
C. Lithium therapy can cause cranial diabetes insipidus
F
D. 50 % of phaeochromocytomas are malignant
F
E. In 5 % of cases, phaeochromocytomas are seen in MEN type II and are due to autosomal dominant inheritance
T
   
11. Psychiatric manifestations of hyperthyroidism may include:  
A. Anxiety
T
B. Depression
T
C. Schizophrenia is more common than mania
T
D. Psychotic depression is more common than mania
F
E. Cognitive impairment
T
   
12. Psychiatric manifestations of hypothyroidism may include:  
A. Paranoia
T
B. Agitation and aggression
T
C. Mania
F
D. Hallucinations never occur
F
E. Slowing of dominant rhythm on EEG
T
   
13. Psychiatric features of Cushing’s syndrome may include:  
A. Less common in men
T
B. Decreased risk of suicide
F
C. Schizophreniform presentation is common
F
D. Depression is common
T
E. Paranoid symptoms are rare
F
   
14. Psychiatric illness with steroid treatment is associated with:  
A. Female
T
B. Higher dose
T
C. Longer duration of therapy
F
D. Previous psychiatric illness
F
E. Depression of mood
F
   
15. Addison’s disease:  
A. Is more common in men
F
B. Depressive illness is usual presentation
T
C. Psychosis is common
F
D. Paranoid symptoms can occur
T
E. Glucocorticoids have little effect on the mental symptoms
F
   
16. Hyperparathyroidism:  
A. Is associated with phaeochromocytoma
T
B. Mood elevation is more common than depression
F
C. Can cause cognitive impairment
T
D. Hallucinations and paranoia are associated with high calcium levels
T
E. Rebound psychosis can occur
T
   
17. Hypoparathyroidism:  
A. Is due to end-organ unresponsiveness to PTH
F
B. Psychiatric symptoms are seen in almost 100 % of idiopathic cases
T
C. Is associated with papilloedema
T
D. Can result in psychosis
T
E. Affective psychoses are common
F
F. Is associated with calcification of the basal ganglia
T
   
18. Acromegaly:  
A. Commonly causes psychosis
F
B. Elation is frequent
T
C. Libido is reduced
T
D. Can present with apathy and lack of spontaneity
T
E. Anxiety is frequent
T
   
19. Hypopituitarism is associated with:  
A. Sarcoidosis
T
B. Childbirth
T
C. Basal skull fracture
T
D. Intracranial infection
T
E. Pituitary tumour
T
   
20. Hypopituitarism:  
A. Generally presents with elevation of mood
F
B. Schizophreniform psychoses are frequent
F
C. Impaired drive quickly responds to therapy
F
D. Can cause reduced libido
T
E. Symptoms occur in only a few patients
F
   
   
   
21. In cerebral anoxia:  
A. Cells of the 3rd, 4th, and 5th cortical layers are more prone to damage
T
B. Cerebellar Purkinje cells are resistant to damage
F
C. Subcortical U-fibres are often spared
T
D. Boundary zone necrosis is most severe in the fronto-temporal areas where the territories of the anterior, middle, and posterior cerebral arteries meet
F
E. Diffuse laminar cortical necrosis does not occur if blood flow is suddenly reduced (e.g. MI)
T
   
22. In carbon monoxide poisoning:  
A. Delirium is characteristically seen before unconsciousness
F
B. Hypotonicity is usually seen
F
C. Hypertonic forms carry a better prognosis
T
D. 20 % of patients have a prolonged period of delirium following poisoning with CO
T
E. Following recovery from coma, if there is complete recovery then there is no further change in presentation
F
   
23. In zinc deficiency:  
A. Hypogeusia and hyposmia are often seen
T
B. Cerebellar signs are seen
T
C. Mania is commonly seen
F
D. Memory is spared
F
E. Emotional lability is seen
T
   
24. In Pellagra:  
A. Nicotinic acid is the main deficiency
T
B. It is a triad of gastrointestinal symptoms, skin changes, and psychiatric disturbance
T
C. The Betz cells of the motor cortex and other nuclei are spared while the Purkinje cells in the cerebellum undergo degeneration
F
D. There is an increased risk of suicide
T
E. Memory impairment is uncommon
F
   
25. Regarding other B vitamin deficiencies:  
A. Panthothenic acid deficiency can lead to seizures
F
B. Pyridoxine has been linked to depressive illness
T
C. Riboflavin can cause the ‘burning feet syndrome’
F
D. Thiamine deficiency can lead to beri-beri
T
E. Pyridoxine is a co-enzyme in GABA breakdown
F
   
26. Regarding Wernicke’s encephalopathy:  
A. The incidence is twice as common in men
T
B. It is associated with prolonged deprivation of thiamine, with an acute fall in levels (e.g. glucose load)
T
C. Confusion, impaired consciousness, and ophthalmoplegia is the classic triad
T
D. Mental abnormalities are seen in all patients
F
E. Hallucinations can occur
T
   
27. In Wernicke’s encephalopathy:  
A. Mamillary bodies are affected
T
B. The walls of the 3rd ventricle are affected
T
C. The hippocampus is spared
T
D. EEG shows diffuse slowing
T
E. The mortality rate is 20 %
T
   
28. Regarding Korsakoff’s psychosis:  
A. Females have a higher incidence
F
B. Females present later than men
F
C. Mamillary bodies are spared
F
D. Memory disturbance is associated with involvement of thalamic nuclei
T
E. SPECT scanning shows increased blood flow in the frontal and anterior temporal lobes
F
   
29. In Vitamin B12 deficiency:  
A. There is a microcytic anaemia
F
B. Polyneuropathy can occur
T
C. Dementia is a feature
T
D. There is a strong association with depressive illness
F
E. There may be memory impairment
T
   
30. Folic acid deficiency:  
A. Can occur in the elderly
T
B. May present with depression
T
C. Depressed people have lower levels of folate
T
D. High levels of folate are seen in dementia
F
E. May occur with anticonvulsant medication
T


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