Q1. In the mental state examination, MOOD refers to: A. What you observe of the patient's emotional expression B. What the patient REPORTS feeling, ideally in their own words C. The patient's diagnosis D. The examiner's impression of the interview ANSWER: B. Why: mood is subjective and reported; AFFECT is objective — what you observe and how it varies during the interview. LEARNING POINT: incongruence between the two is itself a clinical finding, and is lost if they are merged.

Q2. A patient describes, in fluent and logically connected sentences, a fixed false belief that she is being monitored through her television. This is a disorder of: A. Thought FORM B. Thought CONTENT C. Perception D. Speech ANSWER: B — thought content. Why: the ideas connect logically, so form is normal. The belief itself is abnormal, which is disordered content — a delusion. LEARNING POINT: loosening of associations and flight of ideas are disorders of FORM.

Q3. A note reads "Patient aggressive and psychotic. Poor historian." The main problem with this entry is: A. It is too long B. It LABELS without DESCRIBING — the next clinician cannot picture the patient C. It omits the diagnosis D. It should not mention behaviour ANSWER: B. Why: "aggressive" does not say what he did or what preceded it; "psychotic" does not distinguish delusions from hallucinations or disorganised speech; and "poor historian" usually describes the interview. LEARNING POINT: describe observations and quote the patient's own words.

Q4. An older man is referred with agitation, fluctuating confusion and visual hallucinations. A full mental state examination is recorded but no physical examination is performed. The omission is: A. Acceptable in psychiatry B. SERIOUS — this picture suggests DELIRIUM, a physical illness presenting psychiatrically C. Only relevant if he has a fever D. Unimportant if he is oriented ANSWER: B. Why: fluctuating confusion with visual hallucinations in an older patient suggests delirium. Hypoglycaemia, infection, drugs and withdrawal all present psychiatrically. LEARNING POINT: physical examination and basic investigations, including glucose, are part of every psychiatric assessment.

Q5. A patient says he feels "completely fine" but is unkempt, avoids eye contact and speaks in a flat monotone. You should record: A. Only what he says, since mood is subjective B. BOTH — reported mood in his words AND observed affect C. Only your impression D. That he is a poor historian ANSWER: B. Why: recording both preserves the incongruence between subjective mood and objective affect, which is the key finding. LEARNING POINT: seek a collateral history and assess risk directly.

Q6. Which type of hallucination should most prompt a search for an ORGANIC cause? A. Auditory B. VISUAL C. Tactile only D. All equally ANSWER: B — visual. Why: auditory hallucinations predominate in primary psychiatric illness. Prominent visual hallucinations point towards delirium, substances or another organic cause. LEARNING POINT: this is why the MODALITY must be recorded, not just the presence of hallucinations.

Q7. Why is asking a patient directly about suicidal thoughts the correct approach? A. It satisfies documentation requirements B. Asking does NOT increase risk, and indirect questioning produces uninterpretable answers C. It shortens the interview D. It is only necessary in depression ANSWER: B. Why: the fear that asking plants the idea is unfounded, and the question is more often experienced as a relief. Vague questions produce vague answers that cannot support a decision. LEARNING POINT: risk assessment is covered fully in the Delirium and Risk Assessment chapter.