FMGE 2026 - Psychiatry PYQs Practice Questions

Q: A person thinks someone wants to kill him. He cannot be convinced or explained. What is the likely phenomenon?

Delusion. ***Delusion*** - A **delusion** is a fixed, false belief that is resistant to reason or confrontation with actual fact and is not consistent with the person's cultural or educational background. - The specific type described here is a **persecutory delusion**, where the individual believes they are being conspired against or threatened with harm. *Hallucination* - **Hallucinations** are sensory perceptions that occur in the absence of an external stimulus (e.g., hearing voices or seeing things that aren't there). - Unlike delusions, which are disorders of **thought content**, hallucinations are disorders of **perception**. *Illusion* - An **illusion** is a misinterpretation of a real sensory stimulus (e.g., seeing a rope and misinterpreting it as a snake). - This differs from a delusion because it relies on an existing, tangible, external **sensory input**, whereas a delusion is an internally generated false belief. *Obsession* - An **obsession** is an intrusive, unwanted, and recurrent thought, impulse, or image that causes significant anxiety or distress. - The key difference is that the individual with an obsession typically recognizes that the thought is a product of their own mind and is **ego-dystonic**, whereas the deluded individual firmly believes their thought is ** realidade** (reality). [Practice more Psychiatry PYQs on OnCourse]

Q: A 29-year-old female has persistently low mood, doesn’t feel like doing anything, sleeps 15 hours a day, limbs feel heavy, eats a lot for 2 months. She feels happy when she hears her mother is coming to visit her in 2 weeks. Likely diagnosis?

MDD -Atypical features. ***MDD -Atypical features*** - This patient presents with the hallmark symptoms of **atypical depression**, which include **hypersomnia**, **hyperphagia** (increased appetite/weight gain), and **leaden paralysis** (heavy feeling in arms and legs). - A defining feature is **mood reactivity**, where the patient's mood brightens in response to positive external events (like her mother's visit), distinguishing it from melancholic depression. *Mania* - Characterized by a distinct period of **elevated or irritable mood** and **increased energy**, directly opposing the lethargy and low mood seen here. - Patients with mania typically show a **decreased need for sleep**, whereas this patient is sleeping excessively (15 hours). *Adjustment disorder* - This diagnosis requires symptoms to occur in response to an **identifiable stressor** within 3 months of the event; the vignette describes a persistent 2-month period without a specific trigger. - It is a milder condition and usually does not manifest with the specific complex of vegetative symptoms (hypersomnia/hyperphagia) seen in this case. *Anxiety disorder* - While often comorbid with depression, generalized anxiety focuses on **excessive worry** rather than the pervasive low mood and anhedonia (lack of interest) described. - The specific somatic symptoms of leaden paralysis and hyperphagia are more characteristic of depressive disorders with atypical features than primary anxiety states. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient presents with as shown in the image (rabbit -like perioral movements) on long-term treatment. It is caused by which of the following drugs?

Risperidone. ***Risperidone*** - The patient exhibits **tardive dyskinesia**, an involuntary movement disorder characterized by **orofacial dyskinesias** such as "rabbit-like" perioral movements, commonly associated with long-term **antipsychotic** usage. - While atypical antipsychotics carry a lower risk than typical ones, **Risperidone** has a higher risk for **extrapyramidal symptoms** and tardive dyskinesia compared to other second-generation antipsychotics. *Clozapine* - Known as the antipsychotic with the **lowest risk** of inducing tardive dyskinesia, making it the preferred choice for patients who develop these movements on other agents. - Its primary side effect profile is dominated by risks of **agranulocytosis** and **metabolic syndrome**, rather than movement disorders. *Ziprasidone* - Associated with a **low risk** of inducing tardive dyskinesia, similar to other newer atypical antipsychotics. - It is more clinically noted for potential **QT interval prolongation** rather than the development of persistent orofacial involuntary movements. *Fluoxetine* - This is an **SSRI** (Selective Serotonin Reuptake Inhibitor) used for depression and anxiety, not an antipsychotic medication. - While movement disorders like tremor can occasionally occur with SSRIs, classic **tardive dyskinesia** is specifically linked to the blockade of **dopamine D2 receptors** found in antipsychotic therapy. [Practice more Psychiatry PYQs on OnCourse]

Q: An elderly woman is brought to psychiatry OPD by her daughter with complaints of forgetfulness. For the past one year, she has been seeing people and animals in nearby house that has been unoccupied during this period. Also has rigidity. What is the mos t likely type of dementia?

Lewy body dementia. ***Lewy body dementia*** - Characterized by the clinical triad of **visual hallucinations** (often of people or animals), **fluctuating cognition**, and **parkinsonism** (such as rigidity). - Diagnosis relies on the presence of these core features and the **dementia** occurring within a year of the onset of motor symptoms. *Alzheimer’s disease* - Primarily presents with **progressive memory loss** and executive dysfunction without early prominent motor features. - **Visual hallucinations** are typically a late-stage finding rather than an early, characteristic feature like in Lewy body dementia. *Parkinson’s disease* - Features **tremor**, **rigidity**, and **bradykinesia** as the primary symptoms, with cognitive decline occurring much later in the disease course. - If cognitive impairment occurs within one year of motor symptoms, it is clinically classified as **Dementia with Lewy Bodies** (DLB) rather than **Parkinson's Disease Dementia**. *Vascular dementia* - Characterized by a **stepwise decline** in cognitive function associated with **cerebrovascular disease** or stroke events. - Clinical findings usually show **focal neurological deficits** rather than the specific pattern of hallucinations and parkinsonism seen here. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient is getting irritated, having fluctuation of emotions. He reports of hearing voices talking about his actions. He has poor eye contact with the people and wants to stay alone. These symptoms are there for more than two months. Which of the foll owing is pointing towards the diagnosis of schizophrenia and not delusional disorder?

Second person, third person auditory hallucinations. ***Second person, third person auditory hallucinations*** - **Auditory hallucinations** are a hallmark symptom of **schizophrenia**, specifically often described as voices talking about or to the patient in the third person or commenting on their actions. - These hallucinations help differentiate schizophrenia from **delusional disorder**, which is primarily characterized by non-bizarre delusions without significant hallucinations or other prominent **negative symptoms**. *Emotional problem/depression* - While **mood symptoms** can occur in schizophrenia, they are not diagnostic of the disorder itself and are often considered a comorbid feature or part of a schizoaffective presentation. - Emotional flattening and social withdrawal are considered **negative symptoms** that support a diagnosis of schizophrenia, but depression alone is nonspecific and does not confirm psychosis. *Delusion of persecution* - This is a common type of **delusional content** seen in delusional disorder, where fixed, false beliefs are the primary feature of the illness. - In schizophrenia, delusions are often present, but they are typically accompanied by other **psychotic symptoms** like hallucinations, disorganized speech, or catatonia, which are not required for a diagnosis of delusional disorder. *Symptoms are there for more than 2 months* - The duration criterion for schizophrenia requires signs of the disturbance to persist for at least **six months**, including at least one month of symptoms that meet the full diagnostic criteria. - While the duration of greater than one month is necessary for both, the presence of symptoms for two months is insufficient on its own to confirm schizophrenia versus other psychotic disorders without assessing the **nature of the symptoms**. [Practice more Psychiatry PYQs on OnCourse]

Question 1

A person thinks someone wants to kill him. He cannot be convinced or explained. What is the likely phenomenon?

Accepted Answer

Delusion

Answer

Hallucination

Answer

Illusion

Answer

Obsession

Question 2

A 29-year-old female has persistently low mood, doesn’t feel like doing anything, sleeps 15 hours a day, limbs feel heavy, eats a lot for 2 months. She feels happy when she hears her mother is coming to visit her in 2 weeks. Likely diagnosis?

Accepted Answer

MDD -Atypical features

Answer

Mania

Answer

Adjustment disorder

Answer

Anxiety disorder

Question 3

A patient presents with as shown in the image (rabbit -like perioral movements) on long-term treatment. It is caused by which of the following drugs?

Accepted Answer

Risperidone

Answer

Clozapine

Answer

Ziprasidone

Answer

Fluoxetine

Question 4

An elderly woman is brought to psychiatry OPD by her daughter with complaints of forgetfulness. For the past one year, she has been seeing people and animals in nearby house that has been unoccupied during this period. Also has rigidity. What is the mos t likely type of dementia?

Accepted Answer

Lewy body dementia

Answer

Alzheimer’s disease

Answer

Parkinson’s disease

Answer

Vascular dementia

Question 5

A patient is getting irritated, having fluctuation of emotions. He reports of hearing voices talking about his actions. He has poor eye contact with the people and wants to stay alone. These symptoms are there for more than two months. Which of the foll owing is pointing towards the diagnosis of schizophrenia and not delusional disorder?

Accepted Answer

Second person, third person auditory hallucinations

Answer

Emotional problem/depression

Answer

Delusion of persecution

Answer

Symptoms are there for more than 2 months

Question 6

A young boy bright in studies, securing good grades in class now has poor performance. Parents notice a change in behaviour, he avoids speaking to others, often comes home late in the night. Which of the following is the likely cause?

Accepted Answer

Recent drug use

Answer

Depression / Mania

Answer

Personality disorder

Answer

Peer pressure

Question 7

Young adult female who was bullied in class throughout school period, later on in life she started having stage fear, anxiety, low mood. What is the cause of her diagnosis?

Accepted Answer

Social anxiety disorder

Answer

Personality disorder

Answer

Anxiety disorder

Answer

Peer pressure

Question 8

Which paraphilia involves sexual gratification from wearing clothes of opposite gender?

Accepted Answer

Transvestic fetishism

Answer

Eonism

Answer

Fetishism

Answer

Voyeurism

FMGE 2026 — Psychiatry