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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 3^rd or 4^th 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 3^rd or 4^th 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 3^rd, 4^th, and 5^th 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 3^rd 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

Metabolic and Biochemical Disturbances in Psychiatry