Q1. Which type of hallucination should most strongly prompt a search for an ORGANIC cause? A. Auditory B. VISUAL C. Tactile only D. All are equally suggestive ANSWER: B — visual hallucinations. Why: auditory hallucinations predominate in schizophrenia. Prominent visual hallucinations point towards delirium, a substance, or another organic cause. LEARNING POINT: combine this with consciousness level and age of onset to decide how hard to look.

Q2. NEGATIVE symptoms of schizophrenia include: A. Delusions and hallucinations B. BLUNTED EMOTION, poverty of speech and loss of drive C. Thought disorder D. Disorganised behaviour ANSWER: B. Why: negative symptoms are things LOST. They respond poorly to medication and predict long-term function better than the positive symptoms do. LEARNING POINT: they are frequently misread as laziness or depression.

Q3. A 76-year-old develops agitation over two days with visual hallucinations and fluctuating consciousness. The most likely diagnosis is: A. Late-onset schizophrenia B. DELIRIUM C. Generalised anxiety disorder D. Personality disorder ANSWER: B — delirium. Why: three features point away from a primary psychiatric illness — first episode in later life, visual hallucinations, and clouded fluctuating consciousness. Schizophrenia does not impair consciousness. LEARNING POINT: search for the precipitant and check the glucose.

Q4. A man started on an antipsychotic a week ago paces constantly with unbearable inner restlessness. The correct action is: A. Increase the antipsychotic dose B. Recognise AKATHISIA and review the dose and agent C. Add a stimulant D. Discharge him ANSWER: B — akathisia. Why: this is a distressing extrapyramidal adverse effect, easily mistaken for worsening agitation. Increasing the dose makes it worse and is a recognised cause of treatment refusal. LEARNING POINT: ask about side effects directly at every review.

Q5. A patient on an antipsychotic develops fever, marked rigidity, confusion, labile blood pressure and a raised creatine kinase. The immediate priority is: A. Continue the antipsychotic and treat for infection B. STOP the antipsychotic, cool, and give generous fluids C. Increase the antipsychotic D. Await culture results ANSWER: B. Why: this is neuroleptic malignant syndrome. Stopping the drug is the critical step, and fluids protect the kidneys from rhabdomyolysis. LEARNING POINT: fever and rigidity in anyone on an antipsychotic should raise the possibility.

Q6. A woman explains her symptoms in terms of spirit affliction, a belief shared by her family and community. She functions normally with no other psychotic features. This belief: A. Is a delusion and confirms psychosis B. Is NOT a delusion, because it is explained by her culture and shared by her community C. Requires antipsychotic treatment D. Indicates depression ANSWER: B. Why: a delusion is a fixed false belief NOT explained by the person's culture or religion. A shared explanatory model is not psychosis, and mislabelling it damages trust and drives families away from services. LEARNING POINT: assess separately for genuine psychotic features, functional decline and risk.

Q7. Why do people with severe mental illness die substantially earlier than the general population? A. Almost entirely from suicide B. Largely from CARDIOVASCULAR AND METABOLIC disease C. From antipsychotic overdose D. The gap is not real ANSWER: B. Why: although suicide contributes, most of the mortality gap is cardiovascular and metabolic — driven by smoking, antipsychotic metabolic effects, poverty and poorer access to physical healthcare. LEARNING POINT: monitoring weight, glucose, lipids and blood pressure is part of psychiatric care.