MRCPsych Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A patient describes episodes of feeling detached from their surroundings as if watching the world through a glass wall. This is best classified as:
- Depersonalization
- Derealization (Correct answer)
- Dissociative amnesia
- Nihilistic delusion
Correct answer: Derealization
Derealization refers to the subjective experience of the external world feeling unreal, dreamlike, or distant, while the sense of self remains intact.
Question 2: In assessing a patient with suspected alcohol use disorder, the CAGE questionnaire scores 2/4. The most appropriate next step is:
- Discharge with safety netting advice only
- Conduct a full alcohol use history and further clinical assessment (Correct answer)
- Immediately arrange inpatient detoxification
- Prescribe acamprosate without further evaluation
Correct answer: Conduct a full alcohol use history and further clinical assessment
A CAGE score of 2 or more is clinically significant and warrants a comprehensive alcohol use assessment including quantity, frequency, dependence features, and complications.
Question 3: Which of the following best describes 'circumstantiality' in the assessment of thought form?
- Complete inability to reach the intended goal of speech
- Reaching the goal of speech only after excessive, unnecessary detail (Correct answer)
- Sudden shift to an unrelated topic mid-sentence
- Repetition of a word or phrase regardless of context
Correct answer: Reaching the goal of speech only after excessive, unnecessary detail
Circumstantial speech reaches the final point but only after lengthy, over-inclusive, and tangential digressions, unlike tangential speech which never returns to the point.
Question 4: A clinician rates a patient's affect as 'blunted.' What does this specifically describe?
- Affect that rapidly shifts between emotional states
- Reduced intensity and range of emotional expression (Correct answer)
- Total absence of any observable emotional expression
- Affect incongruent with the patient's stated mood
Correct answer: Reduced intensity and range of emotional expression
Blunted affect describes a significant reduction in the intensity of emotional expression, distinct from flat affect (complete absence) and labile affect (rapid shifts).
Question 5: The Mini-Mental State Examination (MMSE) has which significant limitation when used as a sole cognitive screening tool?
- It is too lengthy for routine clinical use
- It has poor sensitivity for frontal lobe and executive dysfunction (Correct answer)
- It cannot be administered to elderly patients
- It does not assess orientation to time or place
Correct answer: It has poor sensitivity for frontal lobe and executive dysfunction
The MMSE primarily assesses language, memory, and orientation, and is relatively insensitive to frontal-executive deficits, making the MoCA or additional frontal tests necessary for comprehensive screening.
Question 6: During assessment, a patient spontaneously volunteers that they recently gave away their prized possessions and have been 'putting their affairs in order.' This should prompt evaluation for:
- Mania with grandiosity
- Suicidal ideation with preparatory behaviors (Correct answer)
- Obsessive-compulsive disorder rituals
- Frontal lobe disinhibition
Correct answer: Suicidal ideation with preparatory behaviors
Giving away possessions and settling affairs are recognized preparatory behaviors that significantly elevate concern for suicide risk and must be directly assessed.
Question 7: Which term describes a patient's subjective account of their own illness experience and emotional state?
- Objective signs
- Premorbid functioning
- Subjective symptoms (history) (Correct answer)
- Mental state examination findings
Correct answer: Subjective symptoms (history)
Subjective symptoms are what the patient reports experiencing, forming part of the psychiatric history, as opposed to objective signs observed during the mental state examination.
MRCPsych Patient Assessment and Evaluation 3
A patient describes episodes of feeling detached from their surroundings as if watching the world through a glass wall.
This is best classified as: