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Question 1
Correct
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A 45-year-old male on an acute psychiatric unit was diagnosed with severe depression with psychotic features. He is being treated with oral haloperidol, venlafaxine, mirtazapine, and procyclidine, but his adherence to the medication regimen is inconsistent. He experiences restlessness, sweating, tremors, shivering, myoclonus, and confusion.
What is the probable reason for these symptoms?Your Answer: Serotonin syndrome
Explanation:The symptoms listed are indicative of serotonin syndrome, which is a potential risk when prescribing two antidepressants. If left untreated, serotonin syndrome can lead to seizures and even death. Treatment typically involves supportive measures such as benzodiazepines and IV access, as well as serotonin receptor antagonists like cyproheptadine. Anticholinergic syndrome, on the other hand, presents with symptoms such as fever, dry skin and mucous membranes, mydriasis, and hyperthermia. Antidepressant discontinuation syndrome can cause a range of neurological, gastrointestinal, and affective symptoms. Idiopathic parkinsonism is characterized by tremors, rigidity, and bradykinesia, while neuroleptic malignant syndrome presents with symptoms such as hyperthermia, rigidity, confusion, tachycardia, and elevated CK and WCC levels.
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This question is part of the following fields:
- Psychopharmacology
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Question 2
Correct
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What is the personality trait that is not included in the big five?
Your Answer: Generosity
Explanation:The Big Five Personality Traits, also known as OCEAN, are five broad categories that can be used to describe an individual’s personality. These categories include Openness to Experience, Conscientiousness, Extraversion (also known as Surgency), Agreeableness, and Neuroticism (also known as Emotional Stability). Each of these traits can be further broken down into specific characteristics that help to define an individual’s personality. For example, Openness to Experience includes traits such as imagination, creativity, and a willingness to try new things. Conscientiousness includes traits such as organization, responsibility, and dependability. Extraversion includes traits such as sociability, assertiveness, and energy level. Agreeableness includes traits such as kindness, empathy, and cooperation. Finally, Neuroticism includes traits such as anxiety, moodiness, and emotional instability. Understanding these personality traits can be helpful in a variety of settings, such as in the workplace of in personal relationships.
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This question is part of the following fields:
- Classification And Assessment
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Question 3
Correct
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What is true about the discontinuation syndrome of antidepressants?
Your Answer: Symptoms rapidly disappear upon readministration of the drug
Explanation:Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).
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This question is part of the following fields:
- Psychopharmacology
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Question 4
Correct
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A 42-year-old woman arrives at the emergency department complaining of sensations in her head that she describes as similar to 'electric shocks'. She has a history of anxiety and depression and has been taking venlafaxine for the past two months, but has a track record of not taking her medication regularly. Apart from that, she is in good health. Her vital signs show a slightly elevated blood pressure, and her routine blood tests and 12-lead ECG are normal. What is the probable cause of her symptoms?
Your Answer: Discontinuation symptoms
Explanation:Discontinuation symptoms are frequently observed in patients taking antidepressants with a shorter half-life, especially venlafaxine of paroxetine. These symptoms can be unsettling, and even patients who are aware of the cause may experience them for several days of longer if they do not resume taking the medication. Malignant hypertension is improbable since the blood pressure is not significantly elevated. Venlafaxine is not typically linked to neuroleptic malignant syndrome.
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This question is part of the following fields:
- Psychopharmacology
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Question 5
Correct
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What structure is situated in the middle cranial fossa?
Your Answer: Foramen lacerum
Explanation:The foramen lacerum is a opening located in the middle cranial fossa at the base of the skull.
Cranial Fossae and Foramina
The cranium is divided into three regions known as fossae, each housing different cranial lobes. The anterior cranial fossa contains the frontal lobes and includes the frontal and ethmoid bones, as well as the lesser wing of the sphenoid. The middle cranial fossa contains the temporal lobes and includes the greater wing of the sphenoid, sella turcica, and most of the temporal bones. The posterior cranial fossa contains the occipital lobes, cerebellum, and medulla and includes the occipital bone.
There are several foramina in the skull that allow for the passage of various structures. The most important foramina likely to appear in exams are listed below:
– Foramen spinosum: located in the middle fossa and allows for the passage of the middle meningeal artery.
– Foramen ovale: located in the middle fossa and allows for the passage of the mandibular division of the trigeminal nerve.
– Foramen lacerum: located in the middle fossa and allows for the passage of the small meningeal branches of the ascending pharyngeal artery and emissary veins from the cavernous sinus.
– Foramen magnum: located in the posterior fossa and allows for the passage of the spinal cord.
– Jugular foramen: located in the posterior fossa and allows for the passage of cranial nerves IX, X, and XI.Understanding the location and function of these foramina is essential for medical professionals, as they play a crucial role in the diagnosis and treatment of various neurological conditions.
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This question is part of the following fields:
- Neurosciences
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Question 6
Incorrect
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What is the highest ranking life event on the social readjustment rating scale according to Holmes and Rahe's research?
Your Answer: Personal injury of illness
Correct Answer: Death of spouse
Explanation:Holmes and Rahe (1967) developed the social readjustment rating scale, which consisted of 43 life events of different levels of severity that appeared to occur before the onset of patients’ illnesses. The researchers analyzed 5000 patient records and found that the death of a spouse was the most serious life event, while a minor violation of the law was the least serious. Although this measure aimed to measure the impact of life events, it has received numerous criticisms, such as its failure to consider individual circumstances and its incomplete list of life events.
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This question is part of the following fields:
- Basic Psychological Processes
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Question 7
Correct
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What is a true statement about 'working memory'?
Your Answer: Its capacity increases with age during childhood
Explanation:Throughout childhood, there is an increase in working memory capacity. Additionally, research has demonstrated that working memory performance can be enhanced, particularly in individuals with ADHD.
Memory Forms
Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.
Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).
Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.
Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).
Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.
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This question is part of the following fields:
- Social Psychology
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Question 8
Correct
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What is a true statement about Angelman syndrome?
Your Answer: It is caused by deleted material from the maternal chromosome
Explanation:Genomic Imprinting and its Role in Psychiatric Disorders
Genomic imprinting is a phenomenon where a piece of DNA behaves differently depending on whether it is inherited from the mother of the father. This is because DNA sequences are marked of imprinted in the ovaries and testes, which affects their expression. In psychiatry, two classic examples of genomic imprinting disorders are Prader-Willi and Angelman syndrome.
Prader-Willi syndrome is caused by a deletion of chromosome 15q when inherited from the father. This disorder is characterized by hypotonia, short stature, polyphagia, obesity, small gonads, and mild mental retardation. On the other hand, Angelman syndrome, also known as Happy Puppet syndrome, is caused by a deletion of 15q when inherited from the mother. This disorder is characterized by an unusually happy demeanor, developmental delay, seizures, sleep disturbance, and jerky hand movements.
Overall, genomic imprinting plays a crucial role in the development of psychiatric disorders. Understanding the mechanisms behind genomic imprinting can help in the diagnosis and treatment of these disorders.
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This question is part of the following fields:
- Genetics
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Question 9
Incorrect
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What is the concept of Conventional Ethics according to Lawrence Kohlberg?
Your Answer: To stand for ethical principles
Correct Answer: To gain approval from others
Explanation:Attachment theory is a framework that emphasizes the importance of secure emotional bonds and resources in shaping an individual’s development and behavior. It highlights the significance of early relationships and experiences in shaping one’s sense of security and ability to form healthy relationships later in life.
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This question is part of the following fields:
- Psychological Development
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Question 10
Incorrect
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Can you identify the brain structure that is not found in both cerebral hemispheres?
Your Answer: Mammillary body
Correct Answer: Pineal gland
Explanation:Neuroanatomical Structures
The pineal gland is a unique structure in the brain that is not present bilaterally. It is a small endocrine gland responsible for producing melatonin, a hormone derived from serotonin. Along with the pituitary gland and circumventricular organs, the pineal gland is one of the few unpaired structures in the brain.
In contrast, the caudate nucleus is a paired structure located within the basal ganglia. It is present bilaterally and plays a crucial role in motor control and learning.
The midbrain contains the Mammillary body, which is also a paired structure involved in long-term memory formation. These structures work together to help us remember and recall past experiences.
Finally, the supraoptic nucleus is duplicated in each cerebral hemisphere. This structure is involved in regulating water balance and plays a critical role in maintaining homeostasis in the body.
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This question is part of the following fields:
- Neurosciences
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Question 11
Correct
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The correct order of the psychosexual stages described by Freud are:
Your Answer: Oral, anal, phallic, latency, genital
Explanation:Developmental Stages
There are four main developmental models that are important to understand: Freud’s theory of psychosexual development, Erikson’s theory of psychosocial development, Piaget’s theory of cognitive development, and Kohlberg’s theory of moral development.
Freud’s theory of psychosexual development includes five stages: oral, anal, phallic, latency, and genital. These stages occur from birth to adulthood and are characterized by different areas of focus and pleasure.
Erikson’s theory of psychosocial development includes eight stages, each with a specific crisis to be resolved. These stages occur from infancy to old age and are focused on developing a sense of self and relationships with others.
Piaget’s theory of cognitive development includes four stages: sensorimotor, preoperational, concrete operational, and formal operational. These stages occur from birth to adulthood and are focused on the development of cognitive abilities such as perception, memory, and problem-solving.
Kohlberg’s theory of moral development includes three stages: preconventional, conventional, and postconventional. These stages occur from childhood to adulthood and are focused on the development of moral reasoning and decision-making.
Understanding these developmental models can help individuals better understand themselves and others, as well as provide insight into how to support healthy development at each stage.
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This question is part of the following fields:
- Psychological Development
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Question 12
Correct
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What is the name of the hormone secreted by the gastrointestinal tract that triggers the sensation of hunger?
Your Answer: Ghrelin
Explanation:Appetite Control Hormones
The regulation of appetite is influenced by various hormones in the body. Neuropeptide Y, which is produced by the hypothalamus, stimulates appetite. On the other hand, leptin, which is produced by adipose tissue, suppresses appetite. Ghrelin, which is mainly produced by the gut, increases appetite. Cholecystokinin (CCK), which is also produced by the gut, reduces appetite. These hormones play a crucial role in maintaining a healthy balance of food intake and energy expenditure.
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This question is part of the following fields:
- Neurosciences
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Question 13
Correct
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Which cranial nerve is solely responsible for either sensory of motor functions and does not have a combination of both?
Your Answer: Abducens
Explanation:Overview of Cranial Nerves and Their Functions
The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.
The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.
The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.
The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.
The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.
The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.
The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.
The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.
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This question is part of the following fields:
- Neurosciences
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Question 14
Incorrect
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Which of the following candidate genes for schizophrenia is located on chromosome 6?
Your Answer: COMT
Correct Answer: DTNBP1
Explanation:Schizophrenia is a complex disorder that is associated with multiple candidate genes. No single gene has been identified as the sole cause of schizophrenia, and it is believed that the more genes involved, the greater the risk. Some of the important candidate genes for schizophrenia include DTNBP1, COMT, NRG1, G72, RGS4, DAOA, DISC1, and DRD2. Among these, neuregulin, dysbindin, and DISC1 are the most replicated and plausible genes, with COMT being the strongest candidate gene due to its role in dopamine metabolism. Low activity of the COMT gene has been associated with obsessive-compulsive disorder and schizophrenia. Neuregulin 1 is a growth factor that stimulates neuron development and differentiation, and increased neuregulin signaling in schizophrenia may suppress the NMDA receptor, leading to lowered glutamate levels. Dysbindin is involved in the biogenesis of lysosome-related organelles, and its expression is decreased in schizophrenia. DISC1 encodes a multifunctional protein that influences neuronal development and adult brain function, and it is disrupted in schizophrenia. It is located at the breakpoint of a balanced translocation identified in a large Scottish family with schizophrenia, schizoaffective disorder, and other major mental illnesses.
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This question is part of the following fields:
- Genetics
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Question 15
Correct
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How does the presence of one APOE4 allele affect the risk of developing Alzheimer's dementia compared to not having any APOE4 allele?
Your Answer: 3
Explanation:Genetics plays a role in the development of Alzheimer’s disease, with different genes being associated with early onset and late onset cases. Early onset Alzheimer’s, which is rare, is linked to three genes: amyloid precursor protein (APP), presenilin one (PSEN-1), and presenilin two (PSEN-2). The APP gene, located on chromosome 21, produces a protein that is a precursor to amyloid. The presenilins are enzymes that cleave APP to produce amyloid beta fragments, and alterations in the ratios of these fragments can lead to plaque formation. Late onset Alzheimer’s is associated with the apolipoprotein E (APOE) gene on chromosome 19, with the E4 variant increasing the risk of developing the disease. People with Down’s syndrome are also at high risk of developing Alzheimer’s due to inheriting an extra copy of the APP gene.
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This question is part of the following fields:
- Genetics
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Question 16
Correct
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From which region of the developing brain does the retina originate?
Your Answer: Diencephalon
Explanation:The retina and optic nerves originate from protrusions of the diencephalon known as eye vesicles during development.
Neurodevelopment: Understanding Brain Development
The development of the central nervous system begins with the neuroectoderm, a specialized region of ectoderm. The embryonic brain is divided into three areas: the forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The prosencephalon further divides into the telencephalon and diencephalon, while the hindbrain subdivides into the metencephalon and myelencephalon.
The telencephalon, of cerebrum, consists of the cerebral cortex, underlying white matter, and the basal ganglia. The diencephalon includes the prethalamus, thalamus, hypothalamus, subthalamus, epithalamus, and pretectum. The mesencephalon comprises the tectum, tegmentum, ventricular mesocoelia, cerebral peduncles, and several nuclei and fasciculi.
The rhombencephalon includes the medulla, pons, and cerebellum, which can be subdivided into a variable number of transversal swellings called rhombomeres. In humans, eight rhombomeres can be distinguished, from caudal to rostral: Rh7-Rh1 and the isthmus. Rhombomeres Rh7-Rh4 form the myelencephalon, while Rh3-Rh1 form the metencephalon.
Understanding neurodevelopment is crucial in comprehending brain development and its complexities. By studying the different areas of the embryonic brain, we can gain insight into the formation of the central nervous system and its functions.
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This question is part of the following fields:
- Neurosciences
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Question 17
Correct
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What is the term for the hallucinations that occur when someone is about to fall asleep?
Your Answer: Hypnagogic hallucinations
Explanation:Hallucinations that occur when falling asleep are called hypnagogic and are typically short and basic, such as simple sounds of flashes of light. Non-complex hallucinations, like sudden noises of brief flashes, are referred to as elementary hallucinations and can happen at any time. Tactile hallucinations are also known as haptic hallucinations. On the other hand, hypnopompic hallucinations are experienced upon waking up. It’s important to note that pseudohallucinations are not related to sleep and do not have the same quality as real perceptions.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 18
Correct
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Age-related plaques are made up of what substances?
Your Answer: Beta amyloid
Explanation:Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.
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This question is part of the following fields:
- Neurosciences
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Question 19
Correct
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Which of the following is linked to losing weight?
Your Answer: Topiramate
Explanation:Topiramate is a medication used for epilepsy and bipolar affective disorder. It works by inhibiting voltage gated sodium channels and increasing GABA levels. Unlike most psychotropic drugs, it is associated with weight loss.
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This question is part of the following fields:
- Psychopharmacology
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Question 20
Correct
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What is the definition of priapism?
Your Answer: A persistent and painful erection
Explanation:Priapism: A Painful and Persistent Erection
Priapism is a condition characterized by a prolonged and painful erection, which can occur in males and even in the clitoris. Although rare, certain medications such as antipsychotics and antidepressants have been known to cause priapism. The primary mechanism behind this condition is alpha blockade, although other mechanisms such as serotonin-mediated pathways have also been suggested. Some of the drugs most commonly associated with priapism include Trazodone, Chlorpromazine, and Thioridazine. Treatment involves the use of alpha-adrenergic agonists, which can be administered orally of injected directly into the penis. Priapism is a serious condition that can lead to complications such as penile amputation, although such cases are extremely rare.
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This question is part of the following fields:
- Psychopharmacology
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Question 21
Incorrect
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What is the likely cause of absent light reflex but normal accommodation in a patient with dementia during an eye examination?
Your Answer: Adie's tonic pupil
Correct Answer: Argyll Robertson pupils
Explanation:Based on the patient’s dementia history, the diagnosis is supported.
Argyll Robertson Pupil: Accommodation Retained
The Argyll Robertson pupil is a notable topic in medical exams, as it is associated with tertiary syphilis, which is a crucial differential diagnosis for various psychiatric conditions like mood disorders, dementia, and psychosis. This type of pupil reacts poorly to light but normally to near stimuli, such as accommodation and convergence. They are typically small and irregular in shape, but they do not usually affect visual acuity. Mydriatic agents are not effective in dilating the Argyll Robertson pupil. Although this type of pupil is often considered pathognomonic of tertiary syphilis, it has also been observed in diabetes.
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This question is part of the following fields:
- Classification And Assessment
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Question 22
Correct
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What is a true statement about XYY syndrome?
Your Answer: It is associated with an increased risk of learning disability
Explanation:XYY Syndrome
XYY Syndrome, also known as Jacobs’ Syndrome of super-males, is a genetic condition where males have an extra Y chromosome, resulting in a 47, XYY karyotype. In some cases, mosaicism may occur, resulting in a 47,XYY/46,XY karyotype. The error leading to the 47,XYY genotype occurs during spermatogenesis of post-zygotic mitosis. The prevalence of XYY Syndrome is as high as 1:1000 male live births, but many cases go unidentified as they are not necessarily associated with physical of cognitive impairments. The most common features are high stature and a strong build, and fertility and sexual development are usually unaffected. In the past, XYY Syndrome was linked to aggressiveness and deviance, but this is likely due to intermediate factors such as reduced IQ and social deprivation. XYY Syndrome is best thought of as a risk factor rather than a cause. There is an increased risk of developmental disorders such as learning difficulties, ASD, ADHD, and emotional problems.
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This question is part of the following fields:
- Genetics
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Question 23
Incorrect
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What is a licensed treatment for bulimia nervosa?
Your Answer: Sertraline
Correct Answer: Fluoxetine
Explanation:Antidepressants (Licensed Indications)
The following table outlines the specific licensed indications for antidepressants in adults, as per the Maudsley Guidelines and the British National Formulary. It is important to note that all antidepressants are indicated for depression.
– Nocturnal enuresis in children: Amitriptyline, Imipramine, Nortriptyline
– Phobic and obsessional states: Clomipramine
– Adjunctive treatment of cataplexy associated with narcolepsy: Clomipramine
– Panic disorder and agoraphobia: Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine
– Social anxiety/phobia: Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine
– Generalised anxiety disorder: Escitalopram, Paroxetine, Duloxetine, Venlafaxine
– OCD: Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Clomipramine
– Bulimia nervosa: Fluoxetine
– PTSD: Paroxetine, Sertraline -
This question is part of the following fields:
- Psychopharmacology
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Question 24
Correct
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Which syndrome was named after a renowned European performer known for their rapid costume changes?
Your Answer: Fregoli syndrome
Explanation:Delusional misidentification is a phenomenon that includes various disorders, such as the Fregoli syndrome, Capgras syndrome, Cotard syndrome, Ganser syndrome, and Othello syndrome. The Fregoli syndrome is characterized by the delusion of doubles, named after the Italian actor Leopoldo Fregoli, who was famous for playing multiple characters in his shows. Capgras syndrome, named after the French psychiatrist Joseph Capgras, involves the delusion that a close family member of friend has been replaced by an identical-looking impostor. Cotard syndrome, named after the French neurologist Jules Cotard, is a rare disorder in which individuals believe that they are dead. Ganser syndrome, named after the German psychiatrist Sigbert Josef Maria Ganser, is a disorder in which individuals give absurd of approximate answers to questions. Finally, Othello syndrome, named after the Shakespearean character, is a psychiatric disorder in which individuals hold a strong delusional belief that their partner is being unfaithful without significant proof.
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This question is part of the following fields:
- History Of Psychiatry
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Question 25
Correct
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What is the probability of an offspring being an asymptomatic carrier if both parents are heterozygous for an autosomal recessive trait?
Your Answer: 50%
Explanation:When two individuals who are heterozygous for an autosomal recessive condition have a child, there is a 25% chance that the child will be affected by the condition, a 50% chance that the child will be a carrier of the condition but not show any symptoms, and a 25% chance that the child will not carry the condition and will be completely normal.
Inheritance Patterns:
Autosomal Dominant Conditions:
– Can be transmitted from one generation to the next (vertical transmission) through all forms of transmission observed (male to male, male to female, female to female).
– Males and females are affected in equal proportions.
– Usually, one parent is an affected heterozygote and the other is an unaffected homozygote.
– If only one parent is affected, there is a 50% chance that a child will inherit the mutated gene.Autosomal Recessive Conditions:
– Males and females are affected in equal proportions.
– Two copies of the gene must be mutated for a person to be affected.
– Both parents are usually unaffected heterozygotes.
– Two unaffected people who each carry one copy of the mutated gene have a 25% chance with each pregnancy of having a child affected by the disorder.X-linked Dominant Conditions:
– Males and females are both affected, with males typically being more severely affected than females.
– The sons of a man with an X-linked dominant disorder will all be unaffected.
– A woman with an X-linked dominant disorder has a 50% chance of having an affected fetus.X-linked Recessive Conditions:
– Males are more frequently affected than females.
– Transmitted through carrier females to their sons (knights move pattern).
– Affected males cannot pass the condition onto their sons.
– A woman who is a carrier of an X-linked recessive disorder has a 50% chance of having sons who are affected and a 50% chance of having daughters who are carriers.Y-linked Conditions:
– Every son of an affected father will be affected.
– Female offspring of affected fathers are never affected.Mitochondrial Inheritance:
– Mitochondria are inherited only in the maternal ova and not in sperm.
– Males and females are affected, but always being maternally inherited.
– An affected male does not pass on his mitochondria to his children, so all his children will be unaffected. -
This question is part of the following fields:
- Genetics
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Question 26
Correct
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Which waveform represents a frequency that is less than 4 Hz?
Your Answer: Delta
Explanation:Electroencephalography
Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.
Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.
Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.
Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.
Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.
Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.
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This question is part of the following fields:
- Neurosciences
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Question 27
Incorrect
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What ECG alterations are commonly observed in patients who are administered lithium at therapeutic doses?
Your Answer: QTc prolongation
Correct Answer: Sinus bradycardia
Explanation:When lithium levels become toxic, which is defined as being greater than 1.5 mEq/L, more serious ECG changes can occur. These include sinoatrial block, intraventricular conduction delay, ST depressions of elevations, the Brugada pattern, and atrioventricular conduction delays.
ECG Changes Associated with Chlorpromazine
Chlorpromazine is a psychotropic medication that has been associated with various ECG changes. One of the most notable changes is repolarization changes, which can be seen as ST segment and T wave changes. Additionally, chlorpromazine has been linked to heart blocks, which can be detected by a prolonged PR interval.
Another significant ECG finding associated with chlorpromazine is QTc prolongation. This is a potentially dangerous condition that can lead to torsades de pointes, a type of ventricular tachycardia that can be life-threatening. Other medications that have been linked to QTc prolongation include a wide range of antipsychotics and antidepressants.
It is important to note that not all patients who take chlorpromazine will experience ECG changes. However, healthcare providers should be aware of the potential risks and monitor patients closely for any signs of cardiac abnormalities. If ECG changes are detected, the medication may need to be adjusted of discontinued to prevent further complications.
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This question is part of the following fields:
- Classification And Assessment
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Question 28
Correct
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What substance has a decay rate that results in a half-life of 75 hours?
Your Answer: Aripiprazole
Explanation:Antipsychotic Half-life and Time to Steady State
Antipsychotic medications are commonly used to treat various mental health conditions, including schizophrenia and bipolar disorder. Understanding the half-life and time to steady state of these medications is important for determining dosing and monitoring their effectiveness.
Aripiprazole has a half-life of 75 hours and takes approximately 2 weeks to reach steady state. Olanzapine has a half-life of 30 hours and takes about 1 week to reach steady state. Risperidone has a half-life of 20 hours when taken orally and takes 2-3 days to reach steady state. Clozapine and Amisulpride both have a half-life of 12 hours and take 2-3 days to reach steady state. Ziprasidone has a shorter half-life of 7 hours and takes 2-3 days to reach steady state. Quetiapine has the shortest half-life of 6 hours and also takes 2-3 days to reach steady state.
Knowing the half-life and time to steady state of antipsychotic medications can help healthcare providers determine the appropriate dosing and frequency of administration. It can also aid in monitoring the effectiveness of the medication and adjusting the treatment plan as needed.
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This question is part of the following fields:
- Psychopharmacology
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Question 29
Incorrect
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Which of the following is not assessed in the MMSE?
Your Answer: Registration
Correct Answer: Executive function
Explanation:Although individuals with executive cognitive dysfunction may receive a normal score on the MMSE, they can still experience significant impairments in their daily functioning.
Mini Mental State Exam (MMSE)
The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.
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This question is part of the following fields:
- Classification And Assessment
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Question 30
Incorrect
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What is the most common condition associated with psychogenic polydipsia?
Your Answer: Generalised anxiety disorder
Correct Answer: Schizophrenia
Explanation:Psychogenic polydipsia is a condition where there is excessive consumption of fluids leading to polyuria, and it is commonly seen in psychiatric conditions such as schizophrenia and developmental disorders. The exact mechanism is unknown, but it is thought to be due to a defect in thirst and a dysfunction in AVP regulation. Patients with psychogenic polydipsia rarely complain of thirst but instead provide delusional explanations for their excessive drinking of state that drinking reduces their anxiety and makes them feel better. If fluid intake exceeds the capacity for excretion, then the resultant hyponatremia may produce signs of water intoxication. It is best managed by fluid restriction. Differential diagnosis should be done to rule out other causes of polyuria and polydipsia. Investigations such as fluid balance charts, urine dipstick, serum U&E and calcium, and urine and plasma osmolality should be arranged. Primary polydipsia can be subclassified into psychogenic and dipsogenic types.
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This question is part of the following fields:
- Classification And Assessment
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