INI-CET High Yield Questions For Psychiatry

Mastering the INI-CET demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in psychiatry that are highly likely to appear on the INI-CET. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of psychiatry concepts, enhancing your confidence and readiness for exam day.

1. During a psychiatric evaluation, a patient displays a communication style characterized by speaking rapidly, providing excessive details, and occasionally getting sidetracked. However, they eventually return to the main topic and answer the question. This phenomenon is known as:

1. Prolixity
2. Flight of ideas
3. Circumstantiality
4. Tangentiality

Correct Option A: Prolixity 

• Prolixity refers to a communication style where thoughts are moving fast, but their speed is less than flight of ideas. The patient speaks rapidly, provides excessive details, and occasionally gets sidetracked. However, they eventually return to the main topic and answer the question. This matches the described scenario, making it the correct answer.

Incorrect Options:

Option B - Flight of ideas

• Flight of ideas is a communication pattern where thoughts follow each other rapidly, and the person may not be able to answer questions because their thoughts are flowing very quickly. They may exhibit illogical and rhyming associations. The described scenario involves the patient returning to the main topic and answering the question, which does not align with a flight of ideas.

Option C - Circumstantiality

• Circumstantiality involves providing excessive and unnecessary details in communication, occasionally getting sidetracked, but ultimately returning to the main topic and answering the question. The thinking proceeds slowly here. Although the scenario shares some similarities with circumstantiality, the term "prolixity" more specifically describes rapid speech and excessive details.

Option D - Tangentiality

• Tangentiality refers to a communication pattern where the person goes off on tangents and never returns to the main topic or fully answers the question. This is different from the described scenario, where the patient eventually returns to the main topic and answers the question.

2. During a routine psychiatric evaluation, a 30-year-old male patient is observed to display unusual motor symptoms. The examiner attempts to move his arms, there is a noticeable resistance initially and then the examiner is able to move the arms freely and makes the patient come in a position as shown in the image below and slowly the arms of the patients come down. Which of the following terms best describes the patient’s behavior?

1. Catalepsy
2. Posturing
3. Waxy flexibility
4. Negativism

Correct Option: C Waxy flexibility

• Waxy flexibility is a motor symptom commonly observed in patients with catatonic features of schizophrenia. It is characterized by the feeling of resistance encountered when attempting to move the patient's limbs or body into different positions. The patient's body seems to exhibit a pliable and moldable quality, similar to the bending of a wax candle. Waxy flexibility is a passive phenomenon, meaning the resistance is felt when the examiner tries to move the patient's body.

Incorrect options:

Option A - Catalepsy

• Catalepsy refers to maintaining an odd posture for an extended period of time. It is a passive phenomenon where the patient maintains the posture in response to external instructions, such as the examiner asking the patient to hold a particular position. Catalepsy does not involve the feeling of resistance encountered during movement, as seen in the described scenario.

Option B - Posturing

• Posturing is similar to catalepsy in that it involves maintaining an odd posture for an extended duration. However, posturing is an active phenomenon where the patient spontaneously assumes the posture without external instructions. In the described scenario, the patient complies with the examiner's request, suggesting a response to external instruction rather than spontaneous posturing.

Option D - Negativism

• Negativism refers to the patient's opposition or lack of response to instructions. It is characterized by a resistance to comply with commands or a tendency to do the opposite of what is requested. While negativism can be observed in patients with catatonic features, it does not specifically describe the motor symptoms mentioned in the scenario.

3. During a routine psychiatric evaluation, a 40-year-old patient presents with symptoms of persistent sadness, loss of interest, and feelings of worthlessness. The patient's facial expression appears flat and lacking in emotional responsiveness. Additionally, the physician notices a physical finding as seen in the picture below. Based on these observations, what clinical signs are associated with this patient's depression?

A. Flat affect and Veraguth's fold

B. Anhedonia and Omega sign

C. Psychomotor agitation and Leaden paralysis

D. Suicidal ideation and Pseudobulbar affect

Correct Option B: Anhedonia and Omega sign

• In the given clinical scenario, the patient's loss of interest (Anhedonia- inability to feel pleasure in normally pleasurable activities), is a common clinical sign of depression. Additionally, an omega-shaped fold on the forehead above the roof of the nose (Omega sign). This sign occurs due to excessive use of the corrugator muscle, which can be observed in some patients with depression. The other options mentioned in the incorrect options are either unrelated or do not match the clinical signs described in the scenario. Psychomotor agitation is excessive motor activity often seen in certain mental disorders, and suicidal ideation is the presence of thoughts related to self-harm or suicide.

4. Jennifer, a 29-year-old woman, gave birth to her first child one week ago. She has been experiencing mood swings, tearfulness, and irritability since the birth. She feels overwhelmed at times but is able to take care of herself and her baby. What is the most likely condition Jennifer is experiencing?

A. Postpartum depression

B. Postpartum psychosis

C. Postpartum blues

D. Postpartum anxiety disorder

Correct Option C: Postpartum blues

• Postpartum blues, also known as "baby blues," is a common condition that affects many women after childbirth. It is characterized by mood swings, tearfulness, irritability, and feeling overwhelmed. However, women with postpartum blues are still able to function and care for themselves and their baby.

Incorrect Options:

Option A - Postpartum depression: Postpartum depression is a more severe and persistent form of mood disturbance that may require pharmacological treatment.

Option B - Postpartum psychosis: Postpartum psychosis is a rare but serious condition characterized by hallucinations, delusions, and severe mood disturbances.

Option D - Postpartum anxiety disorder: Postpartum anxiety disorder involves excessive worry, restlessness, and fear, which are not the primary symptoms described in the scenario.

5. A 62-year-old woman has been accumulating stacks of old clothes in her house for several years. Her living space is cluttered, making it difficult for her to move around. She experiences significant distress and is unable to discard the clothes due to an intense fear of losing something important. Which disorder is most likely present in this patient?

A. Hoarding Disorder

B. Obsessive-Compulsive Disorder (OCD)

C. Generalized Anxiety Disorder (GAD)

D. Major Depressive Disorder

Correct Option A : Hoarding Disorder

• Hoarding disorder is characterized by the excessive acquisition and persistent difficulty discarding possessions, resulting in significant clutter that compromises living spaces and causes distress or impairment. Individuals with hoarding disorder have a strong emotional attachment to their belongings and fear losing them. This behavior is not driven by their value or usefulness but rather by an intense need to save items. Hoarding disorder is often accompanied by feelings of distress, anxiety, and impairment in daily functioning.

Incorrect Options:

Option B - Obsessive-Compulsive Disorder (OCD): Obsessive-Compulsive Disorder is a mental disorder characterized by recurrent obsessions (intrusive thoughts, images, or urges) and/or compulsions (repetitive behaviours or mental acts). While hoarding can be a symptom or subtype of OCD, individuals with OCD may experience other symptoms such as excessive handwashing, checking, or counting. The primary focus of their obsessions and compulsions may not be related to hoarding specifically.

Option C - Generalized Anxiety Disorder (GAD): Generalized Anxiety Disorder is characterized by excessive and uncontrollable worry and anxiety about various aspects of life. While hoarding behavior can be associated with anxiety, GAD typically involves excessive worry about everyday life situations, rather than specific compulsive behaviours related to hoarding.

Option D - Major Depressive Disorder: Major Depressive Disorder is a mood disorder characterized by persistent feelings of sadness, loss of interest or pleasure, changes in appetite and sleep patterns, decreased energy, and difficulty concentrating. While individuals with depression may exhibit symptoms such as a lack of motivation or difficulty organizing their living space, hoarding behavior alone is not indicative of Major Depressive Disorder.

Also Read: INI-CET Previous Year Question Papers

6. A 55-year-old male patient presents with a history of memory impairment and difficulty recalling recent events. He often fabricates false stories to fill memory gaps. On examination, he displays signs of anterograde and retrograde amnesia. Which of the following is the most likely diagnosis

1. Alzheimer's Disease
2. Korsakoff Syndrome
3. Parkinson's Disease
4. Vascular Dementia

Correct Option B: Korsakoff Syndrome

• Based on the given scenario, the patient's chronic onset, impaired recent memory, anterograde and retrograde amnesia, and confabulation are consistent with the diagnosis of Korsakoff Syndrome. Korsakoff Syndrome is primarily caused by Thiamine (Vitamin B1) deficiency and is associated with neuropathologic lesions involving various brain regions.

Incorrect Options:

Option A - Alzheimer's Disease: It is characterized by a progressive decline in memory and cognitive function. While memory impairment is present in both Alzheimer's Disease and Korsakoff Syndrome, confabulation is more commonly associated with Korsakoff Syndrome.

Option C - Parkinson's Disease: It is a neurodegenerative disorder primarily affecting motor function, characterized by symptoms such as tremors, rigidity, and bradykinesia. Memory impairment and confabulation are not typical features of Parkinson's Disease.

Option D - Vascular Dementia: It is caused by cerebrovascular disease, resulting in cognitive decline due to impaired blood flow to the brain. While memory impairment may be present in Vascular Dementia, the presence of confabulation is more indicative of Korsakoff Syndrome.

7. A 45-year-old former professional boxer presents to the clinic with complaints of emotional lability, dysarthria, and impulsivity. He reports a history of repeated head trauma over many years during his boxing career. Based on the clinical presentation and history of head trauma, what is the most likely diagnosis for this patient?

A. Alzheimer's disease

B. Parkinson's disease

C. Dementia pugilistica

D. Vascular dementia

Correct Option C - Dementia pugilistica:

• The clinical scenario described is suggestive of head trauma-related dementia, also known as Dementia pugilistica or punch drunk syndrome. This condition occurs in individuals, particularly boxers, who have experienced repeated head trauma over an extended period of time.

Incorrect Options:

Option A - Alzheimer's disease: Alzheimer's disease presents with progressive memory loss, cognitive decline affecting executive function and language skills, disorientation, impaired judgment, personality changes, and loss of initiative. Individuals may experience mood swings, agitation, and difficulty learning new information. Motor function can be affected in advanced stages, and the disease is characterized by a gradual decline in overall cognitive and functional abilities. Early diagnosis is essential for effective management. The clinical presentation in this patient, along with the history of head trauma, suggests a different diagnosis.

Option B - Parkinson's disease: Parkinson's disease primarily presents with motor symptoms such as tremors, rigidity, and bradykinesia. While cognitive impairment can occur in advanced stages, the prominent features in this patient are emotional lability, dysarthria, and impulsivity, which are not typically associated with Parkinson's disease.

Option D - Vascular dementia: Vascular dementia presents with step-wise progression of cognitive decline, focal neurological deficits, and evidence of cerebrovascular lesions on imaging, the most likely diagnosis for this patient is vascular dementia. The poorly controlled vascular risk factors, such as hypertension and diabetes, contribute to the vascular pathology leading to the cognitive and neurological symptoms. However, the specific clinical features and history of head trauma described in this patient are more indicative of head trauma-related dementia.

8. A 20-year-old female presents with a history of recurrent episodes of binge eating followed by self-induced vomiting. She reports feeling a lack of control over her eating during these episodes. On examination, you notice callus on the knuckles of her hands. Which of the following is the first-line treatment for this condition?

1. Cognitive Behavioural Therapy (CBT)
2. Selective Serotonin Reuptake Inhibitors (SSRIs)
3. Family therapy
4. Electroconvulsive therapy (ECT)

Correct Option A: Cognitive Behavioural Therapy (CBT)

• The first-line treatment for Bulimia Nervosa is Cognitive Behavioural Therapy (CBT). CBT focuses on identifying and modifying unhealthy thoughts and behaviours associated with the disorder. It aims to help individuals develop healthy coping strategies, regulate their eating patterns, and address body image concerns. CBT has been shown to be effective in reducing binge eating episodes and improving overall well-being in individuals with Bulimia Nervosa.
• The presence of calluses on the knuckles, known as Russell's sign, is a physical finding commonly associated with self-induced vomiting in Bulimia Nervosa. This sign is a result of repeated contact between the teeth and knuckles during the act of inducing vomiting.

Incorrect Options:

Option B - Selective Serotonin Reuptake Inhibitors (SSRIs): Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine are commonly used as an adjunct to CBT in the treatment of Bulimia Nervosa. SSRIs can help reduce the frequency of binge eating episodes and improve mood symptoms associated with the disorder. However, CBT is considered the first-line treatment due to its effectiveness and focus on addressing the underlying psychological factors contributing to the condition.

Option C - Family therapy: Family therapy can be beneficial in certain cases, particularly when there are family dynamics that contribute to the maintenance of the disorder.

Option D - Electroconvulsive therapy (ECT): Electroconvulsive therapy (ECT) is not indicated for the treatment of Bulimia Nervosa and is reserved for severe cases of other psychiatric conditions.

9. A 45-year-old patient visits a sleep clinic due to complaints of vivid dreaming and muscle paralysis during sleep. The patient reports experiencing episodes of muscle twitches and complete immobility while mentally awake. Polysomnography is performed to evaluate the sleep architecture.

Which of the following statements about the above mentioned and depicted sleep stage is incorrect?

1. The EEG activity shows increased beta activity similar to the awake state.
2. Sawtooth waves or Sawtooth appearance is a characteristic feature of the EEG in this sleep stage.
3. Rapid eye movements (REM) are observed during this sleep stage.
4. It involves large phasic potentials that originate from midbrain and go towards the medial geniculate body and to the occipital spikes.

Correct Option D - It involves large phasic potentials that originate from the midbrain and go towards the medial geniculate body and to the occipital spikes:

• Correct statement: It involves large phasic potentials that originate from PONS and goes towards the lateral geniculate body and to the occipital spikes (PGO Spikes). 

Incorrect Options:

Option A: The EEG activity shows increased beta activity similar to the awake state: This statement is correct. During REM sleep, the EEG activity is increased and resembles the beta activity seen during wakefulness.

Option B: Sawtooth waves or Sawtooth appearance is a characteristic feature of the EEG in this sleep stage: This statement is correct. Sawtooth waves or Sawtooth appearance is a typical finding in the EEG during REM sleep.

Option C: Rapid eye movements (REM) are observed during this sleep stage: This statement is correct. Rapid eye movements are a prominent feature of REM sleep, which give this stage its name.

10. A 10-year-old child is frequently having difficulty paying attention, is easily distracted, and often fails to complete tasks both at home and school. These difficulties have been present for the past 9 months. Which of the following criteria should be considered for a diagnostic evaluation?

1. Onset of symptoms before 7 years of age, symptoms present in two or more settings, symptoms present for more than 6 months.
2. Onset of symptoms before 12 years of age, symptoms present in one setting only, symptoms present for less than 6 months.
3. Onset of symptoms before 7 years of age, symptoms present in one setting only, symptoms present for more than 6 months.
4. Onset of symptoms before 12 years of age, symptoms present in two or more settings, symptoms present for more than 6 months.

Correct Option A - Onset of symptoms before 12 years of age, symptoms present in two or more settings, symptoms present for more than 6 months.

In the given clinical scenario, several criteria should be considered for a diagnostic evaluation of the child's difficulties:

• Onset of symptoms before 12 years of age: This criterion refers to the symptoms present before the child turned 12 years old.
• Symptoms present in two or more settings: This criterion indicates that the child's attention difficulties should be observed in multiple environments, such as at home and at school. This helps to assess the consistency and pervasiveness of the symptoms across different contexts.
• Symptoms present for more than 6 months: This criterion specifies the duration required for a diagnosis. In this scenario, the child's difficulties have been present for the past 9 months, which exceeds the minimum duration of more than 6 months stated in the diagnostic criteria.

Download the PrepLadder app now to access high-yield content with 24-hr Free Trial. Explore premium study resources like Video Lectures, digital notes, QBank, and Mock Tests for a seamless exam preparation.

Start your INI-CET online coaching journey with PrepLadder.