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MRCPsych Paper 1 Revision

Clinical examination
Questions
May 2010

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1. Which of the following is an open ended question?

A. What is your name?
B. Did you sleep well last night?
C. There is something troubling you. Am I right?
D. What brings you to hospital today?
E. Are you taking your medications as prescribed?

2. 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?
A. Interpretation
B. Clarification
C. Summation
D. Repetition
E. Facilitation

3. In which of the following situations closed questioning is a useful technique?

A. In a highly distracted patient
B. At the later part of interview
C. To rule out less likely symptoms
D. In an overtalkative patient
E. All of the above

4. The reason behind using confrontation technique during clinical interview is to

A. Deal with difficult patients
B. Make patients stop lying to the clinician
C. Reveal some absurd notions that patients might hold
D. Help the patient face a difficult aspect of their problems.
E. Clarify certain associations that patients may not see

5. Which of the following is a supportive technique not aimed at eliciting information?

A. Validation
B. Symptom expectation
C. Interpretation
D. Clarification

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E. Redirection

6. All of the following techniques are useful in facilitating disclosure EXCEPT

A. Silence
B. Validation
C. Suggestive questions
D. Acknowledgement of affect
E. Positive reinforcement

7. Which of the following is a compound question?

A. What is the average height of British women?
B. Do you know how IQ is calculated?
C. Do you go on holidays and are you able to relax then?
D. I think you are not well. Am I right?
E. What can I do for you?
8. Which of the following is an advantage of open ended questions over closed questions?
A. Answers to open questions are less precise
B. Answers to open questions are more informative
C. Answers to open questions are highly reliable
D. Answers to open questions are highly time-saving
E. Answers to open questions are doctor-directed

9. Which of the following is NOT a good technique to use for a poor historian?
A. Use open-ended questions
B. Use verbal and nonverbal facilitation.
C. Shift to neutral ground when necessary
D. Collect information in parts over multiple interviews.
E. Use multiple choice questions

10. In a secluded patient, behavioural observation is carried out every 5th minute through a
glass window. This technique is called
A. Event sampling
B. Time sampling
C. ABC analysis
D. Functional analysis
E. None of the above

11. Which of the following is NOT a good practice while using interpreters?
A. Sticking to the same interpreter for a single case
B. Offering to debrief the interpreter if needed after interpretation
C. Encourage interpretation and then translation of mental status examination
D. Ask the interpreter about degree of guardedness shown by the patient
E. Brief the interpreter before seeing the patient.

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12. In occasional cannabis user, how long is cannabis detected in urine after last use?
A. 12 hours
B. 3 days
C. 3 hours
D. 8 days
E. 4 weeks

13. Lactate 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?
A. Lactic acidosis
B. Panic disorder
C. Lactose intolerance
D. Generalized anxiety disorder
E. Malingering

14. A forensic inpatient is asked to undergo narcoanalysis by the Crown court. Which of the
following statements about narcoanalysis is NOT true?
A. Amobarbital is used
B. Benzodiazepines can be used
C. Organic muteness gets better with amobarbital infusion
D. Psychogenic muteness gets better with amobarbital infusion
E. Useful technique when repression and dissociation are suspected
15. A 32 year old school teacher is admitted for constipation and acute abdominal pain. She
develops motor weakness of her legs on administration of hypnotics and diclofenac. She
experiences visual and tactile hallucinations with intense anxiety. Which of the following
laboratory test is indicated?
A. Serum lipid levels
B. Serum folate
C. Urine glucose
D. Urine porphyrins
E. Serum ceruloplasmin

16. An anorexic patient repeatedly vomits. Which of the following is a possible

complication? (June 2008)
A. Metabolic alkalosis
B. Metabolic acidosis
C. Hypokalaemia
D. Hyponatraemia
E. None of the above

17. 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?
A. Dissociative disorder

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B. Conversion disorder
C. Hypochondriasis
D. Factitious disorder
E. Delusional disorder

18. A 32 year old man has left his wife and children without informing them, has traveled
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?
A. Lymphoma
B. Major depression
C. HIV illness
D. Alcohol dependence
E. Dissociative fugue

19. 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?
A. Golden brown pigmentation around cornea
B. Xanthomas on extensor aspect of forearm
C. Café au lait spots
D. Port wine stain on face
E. Ash leaf macules

20. A patient agrees that he has significant problems with 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?
A. Complete loss of insight
B. Awareness of problems but denial of responsibility
C. Externalization of cause
D. Intellectual insight
E. Emotional insight

21. In MMSE intersecting pentagons primarily assesses which of the following functions?
(June 2008)
A. Copying skills
B. Visual retention
C. Constructional praxis
D. Language
E. Orientation

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22. 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?
A. Stereognosis
B. Right left orientation
C. Finger agnosia
D. Lexical fluency
E. Two point discrimination

23. For the same patient described above, error correction and categorization of objects seem
to be affected. Which of the following is a likely area of lesion?
A. Frontal lobes
B. Parietal lobes
C. Diencephalon
D. Occipital lobe
E. Temporal lobe

24. Alexia without agraphia (pure alexia) is seen in lesions of (June 2008)
A. Anterior cerebral territory
B. Posterior cerebral territory
C. Middles cerebral territory
D. Posterior inferior cerebellar artery
E. Middle meningeal artery

25. Which of the following statements is true with regard to bedside tests of orientation?
A. Intact orientation excludes memory disorders
B. Orientation to person is the most sensitive test
C. Disorientation to one‟s own name indicates hippocampal lesions
D. Orientation to time is often affected in delirium
E. Most patients do not remember the length of time spent in hospital in spite of
intact orientation.

26. Which of the following speech best describes Broca‟s aphasia? (June 2009)
A. Non-fluent aphasia
B. Telegraphic speech
C. Scanning speech
D. Staccato speech
E. Fluent aphasia

27. Which of the following clinical examination for apraxias is abnormal more commonly
with right than left cerebral damage?
A. Construction of polygons
B. Imitating a toothbrush action
C. Using tools appropriately

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D. Whistling and coughing on command

E. Mimicking hand movements

28. Letter cancellation, star cancellation and line bisection tasks examine which of the
following cognitive dysfunction in common?
A. Disorientation
B. Acalculia
C. Agraphia
D. Visual neglect
E. Apraxia

29. Failure of object recognition despite normal sensory input and motor functions is called
A. Neglect
B. Visual agnosia
C. Astereognosis
D. Prosopagnosia
E. Anosognosia

30. A patient presenting with carbon monoxide poisoning is suspected to have bilateral
posterior parietal damage due to anoxia. If this turns out to be Balint‟s syndrome which
of the following is NOT true?
A. Oculomotor apraxia
B. Optic ataxia
C. Simultanagnosia
D. Intact oculocephalic reflexes
E. Diplopia

31. All of the following help localizing a neurological lesion to cerebellum EXCEPT
A. Dysdiadochokinesia
B. Ataxia
C. Hypotonia
D. Ankle clonus
E. Past pointing

32. A 18 year old man presents with bizarre behaviour of picking his clothes and his 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 other hip as a reflex. This is called
A. Positive Kernig‟s sign
B. Positive Brudzinki‟s sign
C. Straight leg raising sign
D. Positive Romberg‟s sign
E. Reverse leg raising sign

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33. 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?
A. Myoclonus
B. Asterixis
C. Athetosis
D. Pronator drift
E. Chorea

34. Which of the following is not a frontal release sign?

A. Glabellar tap
B. Rooting reflex
C. Snout reflex
D. Grasp reflex
E. Cremasteric reflex

35. 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 lesion is likely?
A. Right cerebral hemisphere lesion
B. Left hemisphere lesion
C. Cerebellar vermis lesion
D. Thoracic spinal cord lesion at T12
E. Cranial nerve X nuclei lesion

36. Confrontation test during physical examination is useful to detect which one of the
following?
A. Astigmatism
B. Lens dislocation
C. Cerebellar lesions
D. Lesions of optic tract
E. Myopia

37. 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?
A. Thirteen
B. Eight
C. Sixteen
D. Six
E. Five

38. Which one of the following questionnaires can be used to identify psychiatric 'caseness'
in general population? (June 2008)
a. Structured clinical interview DSM-IV
b. GHQ General Health Questionnaire

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c. PSE Present state examination

d. HAM-D
e. BDI Beck‟s depression inventory

39. Which of the following is characteristic of senile pupil? (October 2008)

a. No changes in light and accommodation reaction
b. Sluggish light and accommodation reaction
c. Sluggish accommodation reaction; preserved light reaction
d. Preserved accommodation reaction; sluggish light reaction
e. Sluggish accommodation and light reaction
40. Serial sevens test is most useful to test one‟s (October 2008)
a. Inattention
b. Concentration
c. Working memory
d. Short term memory
e. IQ
41. Generalised diffuse delta and theta waves in the EEG are seen in (October 2008)
a. Metabolic encephalopathy
b. Temporal lobe seizures
c. CJD
d. Normal Stage 1 sleep
e. Infantile spasms
42. The Clifton Assessment procedure is used in which of the following situations? (October
2008)
a. Care homes for the learning disabled
b. Children in foster care
c. Schizophrenia rehabilitation units
d. Residential care for the elderly
e. Prisons with high mental health burden
43. Considering Beck‟s depression inventory, which of the following is true? (October 2008)
a. It has 21 items
b. Refers to symptoms over the last 5 days.
c. Maximum score is 42
d. Strictly clinician rated scale
e. Has no item on suicidal ideas

44. In schizophrenia the anatomical structure in brain which reduces in size is (October
2008)
a. hippocampus
b. dorsolateral prefrontal cortex
c. cerebellum
d. striatum
e. hypothalamus

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45. Which of the following endocrine changes is noted in Anorexia nervosa? (October 2008)
a. Increased Luteinising Hormone levels
b. Raised growth hormone levels
c. Low thyroxine T4 levels
d. Decreased plasma cortisol levels
e. Decreased carotene levels in plasma

46. Which of the following refers to the extent to which performance on a test fits with
theoretical schema about the test attributes? (June 2009)
a. Concurrent validity
b. Criterion validity
c. Face validity
d. Construct validity
e. Convergent validity
47. The wavelet of EEG that is greater than 13Hz in frequency is (June 2009)
a. Alpha
b. Beta
c. Gamma
d. Delta
e. Theta
48. A patient has normal accommodation reflex but no reaction on testing light reflex. What
is the likely diagnosis? (June 2009: Nov 2009)
a. Holmes Adie pupil
b. Argyll-Robertson pupil
c. Hutchison pupil
d. Marcus Gunn pupil
e. Horner‟s pupil
49. Inability to recognise familiar faces is seen in (June 2009)
a. Anosognosia
b. Prosopognosia
c. Somatognosia
d. Visuospatial apraxia
e. Simultanagnosia
50. Inability to attend to the parts and the whole of an object at the same time is called (June
2009)
a. Anosognosia
b. Prosopognosia
c. Somatognosia
d. Visuospatial apraxia
e. Simultanagnosia

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51. A 29 year old African American man who uses intravenous heroin presents with puffy
face and steady increase in weight despite normal appetite. On examination his blood
pressure is 150/100mmHg. The most likely diagnosis is (June 2009)
a. Opiate withdrawal
b. Hypothyroidism
c. Hepatitis B liver disease
d. Nephropathy
e. HIV seroconversion
52. Which of the following is NOT tested using clock drawing test? (June 2009)
a. Visuospatial ability
b. Comprehension
c. Constructional apraxia
d. Orientation to time
e. Executive function
53. Which of the following SPECT finding is seen in Alzhemier‟s disease? (June 2009)
a. Decrease in temporal perfusion
b. Increase in parietal perfusion
c. Increase in frontal perfusion
d. Increase in temporal perfusion
e. Multiple zones of ischemia in left hemisphere
54. Which of the following is a risk factor for QT prolongation on ECG? (June 2009)
a. Male sex
b. Tachycardia
c. Hypercalcemia
d. Age 25 to 45
e. Hypokalemia
55. Which of the following arteries on occlusion leads to symptoms suggestive of
dorsolateral pre frontal dysfunction? (June 2009)
a. Anterior cerebral
b. Middle cerebral
c. Basilar
d. Peduncular
e. Posterior cerebral
56. A 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? (June 2009)
a. Middle cerebral artery
b. Basilar artery
c. Posterior cerebral artery
d. Anterior cerebral artery
e. Cerebello Pontine artery

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57. A girl attending your outpatient unit is 165 cm tall and weighs 50kg. What is her body
mass index? (June 2009)
a. 16 to 17
b. 17 to 18
c. 18 to 19
d. 19 to 20
e. 20 to 21
58. Which of the following is NOT a component of clock drawing test? (June 2009)
a. Placing the hands of the clock correctly
b. Indicating the hour correctly according to instructions
c. Indicating the minutes correctly according to instructions
d. Using numbers 1 to 12 to create the face of a clock
e. Being aware of the current time when the test is administered
59. Which of the following will you use to assess orientation in a hospitalised patient? (June
2009)
a. Ability to remember his/her own address
b. Ability to repeat a phone number immediately after reading out
c. Ability to correctly identify the doctor when asked to point out
d. Ability to recognise pictures of famous personalities
e. Tap the table once whenever the examiner reads letter „E‟ from a random list of
alphabets
60. 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: (June 2009)
a. Hyperglycaemia
b. Diabetes insipidus
c. SIADH
d. Hyponatraemia
e. Psychogenic polydipsia
61. A depressed patient who is having difficulties with alcohol habit is trying to narrate his
problems with keeping up to his 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? (June 2009)
a. Reinforcement
b. Suggestive lead
c. Setting traps
d. Validation
e. Acknowledgment of affect
62. Concurrent validity is also known as (June 2009)
a. Face validity
b. Predictive validity
c. Incremental validity
d. Criterion validity
e. Construct validity

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63. Copying intersecting polygons in MMSE tests then functions of (June 2009)
a. Temporal lobes
b. Cerebellum
c. Frontal lobes
d. Hippocampus
e. Parietal lobes
64. Clinical features of drug induced hyponatraemia include (June 2009)
a. Constipation
b. Sweating
c. Muscle cramps
d. Diarrhoea
e. Tremors
65. During the interview a doctor tells the patient “I am impressed by what you achieved”.
What type of statement is this? (Nov 2009)

a. Statement of respect
b. Validation
c. Normalisation
d. Counter-transference
e. Negative therapeutic alliance
66. Which of the following is not an alcohol assessment tool? (Nov 2009)
a. AUDIT
b. CAGE
c. SCOFF
d. MAST
e. CIWA
67. Anomic dysphasia is suggestive of a lesion in which of the following regions of brain?
(Nov 2009)

a. Dominant temporo-parietal lesion

b. Dominant fronto-temporal lesion
c. Non-dominant temporo-parietal lesion
d. Non-dominant fronto-temporal lesion
e. Dominant occipital lesion
EMI 1: Neurological examination

1. Match the following clinical signs correctly:

A. Gower‟s sign
B. Milkmaid‟s grip
C. Kayser Flescher ring
D. Marcus Gunn Pupil
E. Argyll Robertson pupil
F. Chvostek‟s sign
G. Ash leaf macules
H. Frontal baldness
I. Shuffling gait

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J. Tuft of hair on midline

Descriptions:
1. A 74 year old man presents with difficulty while turning on bed, tremors even
while at rest, stiffness of both forearm muscles and depression.
2. A 24 year old man presents with bizarre behaviour, anxiety and depression. He
has a bird-like wing beating tremor. On examination liver functions are abnormal
and a genetic disease is suspected.
3. A 4 year old boy ha poor motor development in spite of excellent cognitive
development. He has quite bulky muscles on inspection and no facial
dysmorphism is noted. His brother suffered from a similar problem before he
died of cardiomyopathy at the age of 16.

EMI 2: Physical examination

From the following list of physical examination findings, choose appropriate findings for
each of the description given below.
A. Lanugo hair
B. Dilated pupil
C. Constricted pupil
D. Xanthelasma
E. Goiter
F. Lemon stick appearance
G. Lid lag
H. Mask like face
I. Piloerection
J. Parotid swelling
K. Russell sign
L. Sialorrhea
M. Argyll Robertson Pupil

Descriptions:

1. An 18 year old girl hides food in cup boards, refuses to sit with others while
eating and has lost considerable weight over last 6 months. She is a high flyer at
school but recently her performance is declining She does not induce vomiting
but exercises for 3 hours a day.(ONE).
2. A 22 year old woman who has a previous history of eating disorder not otherwise
specified, attends clinic with history of uncontrollable episodes of overeating that
culminates in purging and vomiting. She has maintained reasonable weight but
feels she has lost control over her eating again. (TWO)
3. A 43 year old heroine user presents to the A&E demanding a strong pain killer
for stomach ache. He threatens to bleed himself to death if he is not given a
parenteral opioid analgesic (TWO).

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4. A 33 year old man has been started on clozapine 3 weeks ago but has developed
pneumonia recently. His WBC count is normal (ONE).

EMI 3: Assessment instruments

For each description below choose an option from the list of scales given:
A. Minnesota multiphasic personality inventory
B. Beck‟s depression scale
C. Present status examination
D. General Health Questionnaire
E. Positive and Negative symptoms scale
F. Diagnostic interview scale
G. Global assessment of functioning
H. Health of Nations Outcome Scale
I. CAGE questionnaire
J. International Personality Disorder Examination
K. Yale Brown Obsessive compulsive scale

Description:

1. A 34 year old woman complains of loss of weight and appetite for last 2 months.
She has poor sleep and has multiple somatic complaints that started when she and
her husband separated 3 months ago. She denies using alcohol.
2. A researcher is interested in finding out the degree of self rated psychiatric
symptoms in a sample of 125 diabetic outpatients attending an insulin clinic.
3. As a part of a new World Mental Health initiative, it is planned to conduct a
nationwide survey of mental health burden. It is planned to administer a fully
structured instrument through trained non-clinical research workers to ascertain
lifetime diagnosis of mental illness.
4. A newly constituted mental health trust wants to adopt a common scale for
monitoring clinical recovery on discharge across different adult units.
EMI 4 Localising signs:

A. Anosognosia
B. Gait Ataxia
C. Bilateral 6th nerve palsy
D. Left 4th nerve palsy
E. Ipsilateral optic atrophy
F. Gertsmann‟s Syndrome
G. Constructional Apraxia
H. Anosmia

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I. Agraphia

Choose two symptoms for each of the following conditions:

1. A malnourished alcoholic. (TWO)

2. A right-handed person with right parietal lobe lesion. (TWO)
3. A frontal meningioma. (TWO)

EMI 5: Neuropsychological tests

A. Cognitive Estimates Test

B. Digit span
C. Go - No Go test
D. Mini Mental State Examination
E. National Adult Reading Test
F. Raven‟s progressive matrices
G. Rivermead Behavioural Memory Test
H. Stroop test
I. Wechsler Memory Scale
J. Wisconsin Card Sorting Test

A 54 year man presents with a year‟s history of steadily progressive personality change.
He has become increasingly apathetic and appears depressed but his main complaint is of
increasing frontal headaches. On examination he has word finding difficulties. EEG
shows frontal slowing, greater on the left. You are concerned that he may have an
intracranial space occupying lesion

1. Which test would you use to obtain a quick estimate of his

current performance IQ?
2. The test indicates that his current performance IQ is in the low
average range. Which test would enable you to estimate his IQ
before any brain damage he may have sustained in recent months
/ years?
3. The estimate of his premorbid IQ is 15 points higher than his
current performance IQ. It is recommended that he has a full
WAIS IQ assessment to measure both performance and verbal
IQ. On the WAIS his verbal IQ is found to be impaired over and
above his performance IQ. Which test is part of the WAIS verbal
subtests?
4. An MRI scan shows a large meningioma compressing
dorsolateral prefrontal cortex on the left. Which test result is
most likely to be impaired?

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