
Question 1
Correct

What is the most effective treatment for premenstrual dysphoric disorder?
Your Answer: Fluoxetine
Explanation:There is currently no evidence to support the use of vitamin supplements for the treatment of premenstrual dysphoric disorder. However, lifestyle changes such as regular exercise, a healthy diet, and stress reduction techniques may be helpful in managing symptoms. It is important to consult with a healthcare provider to determine the best course of treatment for individual cases of PMDD.

This question is part of the following fields:
 General Adult Psychiatry


Question 2
Incorrect

A teenager is referred by the transplant team with moderate depression following a recent operation. They are prescribed cyclosporin. Which of the following would be the least appropriate antidepressant in this case?
Your Answer: Amitriptyline
Correct Answer: Nefazodone
Explanation:The primary metabolic pathway for cyclosporin involves the CYP3A3/4 isoenzymes. When this system is inhibited, toxic levels of cyclosporin can accumulate. Reports have shown that interactions with nefazodone and fluvoxamine can lead to cyclosporine toxicity. Vella (1998) published a study on the interactions between cyclosporine and newer antidepressant medications in the American Journal of Kidney Diseases, which supports these findings.
Interactions of Antidepressants with Cytochrome P450 System
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can have significant effects on the cytochrome P450 system. This can result in drug interactions that can affect the efficacy and safety of the medications.
One example of such interaction is between fluvoxamine and theophylline. Fluvoxamine is a potent inhibitor of CYP1A2, which can lead to increased levels of theophylline in the body. This can cause adverse effects such as nausea, vomiting, and tremors.
Another example is between fluoxetine and clozapine. Fluoxetine is a potent inhibitor of CYP2D6, which can increase the risk of seizures with clozapine. Clozapine is metabolized by CYP1A2, CYP3A4, and CYP2D6, and any inhibition of these enzymes can affect its metabolism and increase the risk of adverse effects.
It is important to be aware of these interactions and monitor patients closely when prescribing antidepressants, especially in those who are taking other medications that are metabolized by the cytochrome P450 system.

This question is part of the following fields:
 General Adult Psychiatry


Question 3
Correct

What is the accurate formula for determining the likelihood ratio of a negative test result?
Your Answer: (1  sensitivity) / specificity
Explanation:Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and posttest odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating posttest probabilities.

This question is part of the following fields:
 Research Methods, Statistics, Critical Review And EvidenceBased Practice


Question 4
Incorrect

Which genetic disorder has a subtype that is linked with almost 100% occurrence of psychotic symptoms in later life?
Your Answer: RubensteinTaybi syndrome
Correct Answer: PraderWilli syndrome
Explanation:Individuals with PraderWilli syndrome can be classified into three genetic subtypes: deletion, maternal disomy, and imprinting defect. The maternal disomy subtype is particularly linked to an increased risk of developing psychosis later in life.

This question is part of the following fields:
 Psychiatry Of Learning Disability


Question 5
Incorrect

A previous truck driver has been effectively treated with olanzapine after being diagnosed with schizophrenia and hopes to eventually go back to his former job. According to the DVLA, how long must the individual be in good and stable condition before they can resume driving?
Your Answer: 6 months
Correct Answer: 36 months
Explanation:For individuals diagnosed with chronic psychosis, the DVLA mandates a minimum of 3 months of stability before they can resume driving standard cars and motorcycles. However, for those driving LGVs of PCVs, this period is extended to 3 years. Similar guidelines apply to those with acute psychotic disorders and hypomania/mania. In the case of severe anxiety of depression, LGV/PCV drivers may be allowed to resume driving after 6 months of stability.

This question is part of the following fields:
 Organisation And Delivery Of Psychiatric Services


Question 6
Correct

Which of the following is calculated by dividing the standard deviation by the square root of the sample size?
Your Answer: Standard error
Explanation:The formula for the standard error of the mean is equal to the standard deviation divided by the square root of the number of patients.
Measures of dispersion are used to indicate the variation of spread of a data set, often in conjunction with a measure of central tendency such as the mean of median. The range, which is the difference between the largest and smallest value, is the simplest measure of dispersion. The interquartile range, which is the difference between the 3rd and 1st quartiles, is another useful measure. Quartiles divide a data set into quarters, and the interquartile range can provide additional information about the spread of the data. However, to get a more representative idea of spread, measures such as the variance and standard deviation are needed. The variance gives an indication of how much the items in the data set vary from the mean, while the standard deviation reflects the distribution of individual scores around their mean. The standard deviation is expressed in the same units as the data set and can be used to indicate how confident we are that data points lie within a particular range. The standard error of the mean is an inferential statistic used to estimate the population mean and is a measure of the spread expected for the mean of the observations. Confidence intervals are often presented alongside sample results such as the mean value, indicating a range that is likely to contain the true value.

This question is part of the following fields:
 Research Methods, Statistics, Critical Review And EvidenceBased Practice


Question 7
Correct

What is the negative predictive value of the blood test for bowel cancer, given a sensitivity of 60% and a specificity of 80% and a negative test result for a patient?
Your Answer: 0.5
Explanation:Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and posttest odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating posttest probabilities.

This question is part of the following fields:
 Research Methods, Statistics, Critical Review And EvidenceBased Practice


Question 8
Correct

After creating a scatter plot of the data, what would be the next step for the researcher to determine if there is a linear relationship between a person's age and blood pressure?
Your Answer: Pearson's coefficient
Explanation:Choosing the right statistical test can be challenging, but understanding the basic principles can help. Different tests have different assumptions, and using the wrong one can lead to inaccurate results. To identify the appropriate test, a flow chart can be used based on three main factors: the type of dependent variable, the type of data, and whether the groups/samples are independent of dependent. It is important to know which tests are parametric and nonparametric, as well as their alternatives. For example, the chisquared test is used to assess differences in categorical variables and is nonparametric, while Pearson’s correlation coefficient measures linear correlation between two variables and is parametric. Ttests are used to compare means between two groups, and ANOVA is used to compare means between more than two groups. Nonparametric equivalents to ANOVA include the KruskalWallis analysis of ranks, the Median test, Friedman’s twoway analysis of variance, and Cochran Q test. Understanding these tests and their assumptions can help researchers choose the appropriate statistical test for their data.

This question is part of the following fields:
 Research Methods, Statistics, Critical Review And EvidenceBased Practice


Question 9
Correct

What is a true statement about self harm?
Your Answer: Older people who selfharm often have a degree of suicidal intent
Explanation:Self Harm in Older Adults
Self harm in older adults should be taken very seriously as it often indicates suicidal intent. The NICE guidelines on Self Harm (2004) recommend that all acts of selfharm in people over 65 years of age should be regarded as evidence of suicidal intent until proven otherwise. This is because the number of older adults who complete suicide is much higher than in younger adults.
Unfortunately, many individuals who selfharm never receive psychiatric care and are discharged from emergency departments without any psychosocial needs assessment. This is contrary to the 2004 recommendations by the UK’s National Institute for Health and Clinical Excellence (NICE) for those who selfharm.
Self harm can take many forms, including overdose, cutting, burning, hitting of mutilating body parts, and attempted hanging of strangulation. It is important to recognize the signs of self harm and provide appropriate support and care to those who engage in this behavior.

This question is part of the following fields:
 General Adult Psychiatry


Question 10
Incorrect

A 70yearold patient with cognitive impairment, who was discharged from section 2 of the Mental Health Act a month ago and was under Deprivation of Liberty Safeguards, has been discovered deceased in her care home with an empty bottle of opioids beside her bed. Why is it necessary to notify the coroner?
Your Answer: Because the patient has recently been detained under the MHA
Correct Answer: Because the death appears to be due to selfinflicted poisoning
Explanation:Guidance for Registered Medical Practitioners on the Notification of Deaths Regulations 2019
If there is reason to suspect that the deceased died from selfinflicted poisoning, the coroner should be informed. The Notification of Deaths Regulations 2019 provides national guidance for registered medical practitioners on reporting deaths. This guidance supersedes any local protocols. There are several causes of death that must be referred to the coroner, including death from poisoning, violence of trauma, selfharm, neglect, medical procedures, employmentrelated injury of disease, unnatural death, unknown cause of death, death in state detention, and unidentified individuals. This does not include patients recently detained under the Mental Health Act of subject to DOLS, unless one of the above reasons applies.

This question is part of the following fields:
 Organisation And Delivery Of Psychiatric Services

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