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  • Question 1 - What test can be used to detect constructional apraxia? ...

    Correct

    • What test can be used to detect constructional apraxia?

      Your Answer: Clock drawing test

      Explanation:

      Individuals with constructional apraxia are unable to replicate drawings of arrange objects to create patterns of designs.

      Clock Drawing Test: A Screening Tool for Cognitive Dysfunction

      The clock drawing test is a widely used screening tool for cognitive dysfunction. It involves asking the patient to draw a clock on a piece of paper, placing the numbers on the clock face and drawing the hands to indicate 10 minutes past 11. This simple task assesses a range of cognitive functions, including visuospatial ability, motor function, attention, and comprehension.

      The test is quick and easy to administer, making it a useful tool for healthcare professionals to identify potential cognitive impairment in patients. The clock drawing test has been shown to be effective in detecting cognitive dysfunction in a variety of conditions, including Alzheimer’s and Parkinson’s disease.

      The image below illustrates examples of clocks drawn correctly by healthy controls and those drawn by patients with Alzheimer’s and Parkinson’s disease. By comparing the drawings, healthcare professionals can quickly identify potential cognitive dysfunction and take appropriate action.

    • This question is part of the following fields:

      • Classification And Assessment
      7.2
      Seconds
  • Question 2 - What is the most common symptom associated with primary progressive aphasia? ...

    Incorrect

    • What is the most common symptom associated with primary progressive aphasia?

      Your Answer: Posterior temporal lobe atrophy more pronounced than anterior temporal lobe

      Correct Answer: Atrophy of left perisylvian region

      Explanation:

      Primary progressive aphasia is a specific type of frontotemporal dementia that is characterized by the degeneration of the left perisylvian region. Frontotemporal dementia can be divided into two subtypes: behavioral, which involves atrophy of the frontal region, and language, which includes primary progressive aphasia and semantic dementia. The language subtypes of frontotemporal dementia typically exhibit more severe atrophy on the left side of the brain. Semantic dementia is characterized by greater atrophy in the anterior temporal lobe compared to the posterior temporal lobe. In contrast, Alzheimer’s dementia is associated with bilateral hippocampal atrophy, while vascular dementia is characterized by diffuse white matter lesions.

    • This question is part of the following fields:

      • Neurosciences
      20.2
      Seconds
  • Question 3 - Which medication(s) have been associated with extrapyramidal side effects? ...

    Incorrect

    • Which medication(s) have been associated with extrapyramidal side effects?

      Your Answer: Procyclidine

      Correct Answer: Fluoxetine

      Explanation:

      EPSE’s have been linked to the use of fluoxetine, and all of the treatment options are utilized to address them.

      Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).

    • This question is part of the following fields:

      • Psychopharmacology
      7.5
      Seconds
  • Question 4 - What is a personality disorder that falls under cluster A? ...

    Incorrect

    • What is a personality disorder that falls under cluster A?

      Your Answer: Borderline

      Correct Answer: Paranoid

      Explanation:

      Personality Disorder Classification

      A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.

      Course

      Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.

      Classification

      The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.

      UK Epidemiology

      The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.

    • This question is part of the following fields:

      • Classification And Assessment
      6.7
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  • Question 5 - What is a true statement about valproate? ...

    Correct

    • What is a true statement about valproate?

      Your Answer: The risk of congenital malformations is dose dependent

      Explanation:

      Valproate can pass through the placenta, increasing the likelihood of birth defects. The extent of risk during pregnancy is not fully understood, but it is believed to be influenced by the dosage. Children who were exposed to valproate in the womb may have a lower IQ, with those aged 6 showing an average decrease of 7-10 points compared to those exposed to other antiepileptic medications.

      Valproate: Forms, Doses, and Adverse Effects

      Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.

      Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.

      Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.

    • This question is part of the following fields:

      • Psychopharmacology
      10.4
      Seconds
  • Question 6 - What is a true statement about lithium? ...

    Correct

    • What is a true statement about lithium?

      Your Answer: It exists in an unbound form in the blood

      Explanation:

      Lithium has a tendency to remain unattached to proteins and instead remains unbound within the body, resulting in its efficient elimination from the bloodstream through haemodialysis.

      Lithium – Pharmacology

      Pharmacokinetics:
      Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

      Ebstein’s:
      Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

      Contraindications:
      Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

      Side-effects:
      Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

      Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

      Lithium-induced diabetes insipidus:
      Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

      Toxicity:
      Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

      Pre-prescribing:
      Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Monitoring:
      Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

    • This question is part of the following fields:

      • Psychopharmacology
      26.5
      Seconds
  • Question 7 - Who proposed the six fundamental emotions that are believed to be universally present...

    Correct

    • Who proposed the six fundamental emotions that are believed to be universally present in all humans?

      Your Answer: Paul Ekman

      Explanation:

      Primary Emotions

      Paul Ekman, a renowned psychologist, identified six basic emotions that he believed were universally present in all humans. These primary emotions are happiness, fear, disgust, sadness, anger, and surprise. Ekman suggested that these emotions were biologically innate and could be recognized across different cultures and languages. Although he later added more emotions to this list, the original six remain the most commonly referenced. Understanding these primary emotions can help individuals better recognize and manage their own emotions, as well as empathize with others.

    • This question is part of the following fields:

      • Social Psychology
      465.6
      Seconds
  • Question 8 - Which ion channel blockade is believed to be the primary cause of the...

    Incorrect

    • Which ion channel blockade is believed to be the primary cause of the arrhythmogenic potential of tricyclic antidepressants?

      Your Answer: Potassium

      Correct Answer: Sodium

      Explanation:

      Antidepressants and Their Cardiac Effects

      SSRIs are generally recommended for patients with cardiac disease as they may protect against myocardial infarction (MI). Untreated depression worsens prognosis in cardiovascular disease. Post MI, SSRIs and mirtazapine have either a neutral of beneficial effect on mortality. Sertraline is recommended post MI, but other SSRIs and mirtazapine are also likely to be safe. However, citalopram is associated with Torsades de pointes (mainly in overdose). Bupropion, citalopram, escitalopram, moclobemide, lofepramine, and venlafaxine should be used with caution of avoided in those at risk of serious arrhythmia (those with heart failure, left ventricular hypertrophy, previous arrhythmia, of MI).

      Tricyclic antidepressants (TCAs) have established arrhythmogenic activity which arises as a result of potent blockade of cardiac sodium channels and variable activity at potassium channels. ECG changes produced include PR, QRS, and QT prolongation and the Brugada syndrome. Lofepramine is less cardiotoxic than other TCAs and seems to lack the overdose arrhythmogenicity of other TCAs. QT changes are not usually seen at normal clinical doses of antidepressants (but can occur, particularly with citalopram/escitalopram). The arrhythmogenic potential of TCAs and other antidepressants is dose-related.

      Overall, SSRIs are recommended for patients with cardiac disease, while caution should be exercised when prescribing TCAs and other antidepressants, especially in those at risk of serious arrhythmia. It is important to monitor patients closely for any cardiac effects when prescribing antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
      37.5
      Seconds
  • Question 9 - How is clinical research currently guided worldwide in terms of ethical recommendations? ...

    Incorrect

    • How is clinical research currently guided worldwide in terms of ethical recommendations?

      Your Answer:

      Correct Answer: Helsinki declaration

      Explanation:

      The Significance of the Declaration of Helsinki in Biomedical Research Ethics

      The Declaration of Helsinki, created by the World Medical Association in 1964, outlines the fundamental ethical principles that govern biomedical research involving human subjects. Over the years, it has undergone several revisions and continues to serve as a cornerstone of good medical practice. Its importance lies in its ability to provide a framework for ethical decision-making in research, ensuring that the rights, safety, and well-being of human subjects are protected. The Declaration of Helsinki is a crucial document that guides researchers, clinicians, and policymakers in their efforts to conduct ethical and responsible research.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 10 - What is a correct statement about the blood brain barrier? ...

    Incorrect

    • What is a correct statement about the blood brain barrier?

      Your Answer:

      Correct Answer: Nasally administered drugs can bypass the blood brain barrier

      Explanation:

      Understanding the Blood Brain Barrier

      The blood brain barrier (BBB) is a crucial component of the brain’s defense system against harmful chemicals and ion imbalances. It is a semi-permeable membrane formed by tight junctions of endothelial cells in the brain’s capillaries, which separates the blood from the cerebrospinal fluid. However, certain areas of the BBB, known as circumventricular organs, are fenestrated to allow neurosecretory products to enter the blood.

      When it comes to MRCPsych questions, the focus is on the following aspects of the BBB: the tight junctions between endothelial cells, the ease with which lipid-soluble molecules pass through compared to water-soluble ones, the difficulty large and highly charged molecules face in passing through, the increased permeability of the BBB during inflammation, and the theoretical ability of nasally administered drugs to bypass the BBB.

      It is important to remember the specific circumventricular organs where the BBB is fenestrated, including the posterior pituitary and the area postrema. Understanding the BBB’s function and characteristics is essential for medical professionals to diagnose and treat neurological disorders effectively.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 11 - What is the most common cause of amenorrhoea? ...

    Incorrect

    • What is the most common cause of amenorrhoea?

      Your Answer:

      Correct Answer: Amisulpride

      Explanation:

      Antipsychotic use can lead to high levels of prolactin, which can cause amenorrhea. To address hyperprolactinemia, aripiprazole, quetiapine, and olanzapine are recommended. However, clozapine typically does not impact prolactin release.

      Hyperprolactinemia is a potential side effect of antipsychotic medication, but it is rare with antidepressants. Dopamine inhibits prolactin, so dopamine antagonists, such as antipsychotics, can increase prolactin levels. The degree of prolactin elevation is dose-related, and some antipsychotics cause more significant increases than others. Hyperprolactinemia can cause symptoms such as galactorrhea, menstrual difficulties, gynecomastia, hypogonadism, and sexual dysfunction. Long-standing hyperprolactinemia in psychiatric patients can increase the risk of osteoporosis and breast cancer, although there is no conclusive evidence that antipsychotic medication increases the risk of breast malignancy and mortality. Some antipsychotics, such as clozapine and aripiprazole, have a low risk of causing hyperprolactinemia, while typical antipsychotics and risperidone have a high risk. Monitoring of prolactin levels is recommended before starting antipsychotic therapy and at three months and annually thereafter. Antidepressants rarely cause hyperprolactinemia, and routine monitoring is not recommended. Symptomatic hyperprolactinemia has been reported with most antidepressants, except for a few, such as mirtazapine, agomelatine, bupropion, and vortioxetine.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 12 - How can we differentiate between a pseudohallucination and a true hallucination? ...

    Incorrect

    • How can we differentiate between a pseudohallucination and a true hallucination?

      Your Answer:

      Correct Answer: Occurs in inner subjective space

      Explanation:

      The distinguishing factors between the two are based on personal interpretation and tangible versus intangible concepts.

      Altered Perceptual Experiences

      Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.

      Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.

      Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 13 - You receive a call from a fellow physician who is worried she might...

    Incorrect

    • You receive a call from a fellow physician who is worried she might be experiencing panic disorder. What symptom is most indicative of this diagnosis?

      Your Answer:

      Correct Answer: Episodic anxiety

      Explanation:

      Panic disorder is a mental health condition that is characterized by sudden and intense episodes of anxiety that often occur without warning. Physical symptoms such as palpitations and dizziness are common during these episodes. Fear of collapsing of dying is a common psychological symptom associated with this disorder. Free-floating anxiety is a feature of generalized anxiety disorder, while situational anxiety is more characteristic of specific phobic anxiety. The International Classification of Diseases (ICD-10) classifies panic disorder as F41.0, also known as episodic paroxysmal anxiety.

    • This question is part of the following fields:

      • Diagnosis
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  • Question 14 - A 45-year-old patient with schizophrenia has persistent delusions of persecution and is convinced...

    Incorrect

    • A 45-year-old patient with schizophrenia has persistent delusions of persecution and is convinced that the government is spying on him through his television.
      His new roommate, who has a cognitive impairment, begins to share the same belief and has placed aluminum foil over all the windows.
      What is the most probable scenario?

      Your Answer:

      Correct Answer: Folie imposée

      Explanation:

      Folie a deux is a type of shared psychosis where a mentally healthy person adopts the delusional beliefs of a mentally ill person with whom they have a close relationship. The mentally ill person is the primary individual with the delusion, while the mentally healthy person is the secondary individual who acquires the delusion. There are four different types of relationships between the primary and secondary individuals: folie imposée, folie communiqué, folie induite, and folie simultanée. In folie imposée, the delusions of the mentally ill person are imposed on the mentally healthy person, who may have some social of psychological disadvantage. In folie communiqué, the mentally healthy person initially resists the delusion but eventually adopts it and maintains it even after separation from the mentally ill person. In folie induite, a person who is already psychotic incorporates the delusions of a closely associated primary individual into their own delusional system. In folie simultanée, two of more people become psychotic and share the same delusional system at the same time.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 15 - What proportion of all multiple sclerosis cases is accounted for by primary progressive...

    Incorrect

    • What proportion of all multiple sclerosis cases is accounted for by primary progressive multiple sclerosis?

      Your Answer:

      Correct Answer: 10%

      Explanation:

      Multiple Sclerosis: An Overview

      Multiple sclerosis is a neurological disorder that is classified into three categories: primary progressive, relapsing-remitting, and secondary progressive. Primary progressive multiple sclerosis affects 5-10% of patients and is characterized by a steady progression with no remissions. Relapsing-remitting multiple sclerosis affects 20-30% of patients and presents with a relapsing-remitting course but does not lead to serious disability. Secondary progressive multiple sclerosis affects 60% of patients and initially presents with a relapsing-remitting course but is then followed by a phase of progressive deterioration.

      The disorder typically begins between the ages of 20 and 40 and is characterized by multiple demyelinating lesions that have a preference for the optic nerves, cerebellum, brainstem, and spinal cord. Patients with multiple sclerosis present with a variety of neurological signs that reflect the presence and distribution of plaques. Ocular features of multiple sclerosis include optic neuritis, internuclear ophthalmoplegia, and ocular motor cranial neuropathy.

      Multiple sclerosis is more common in women than in men and is seen with increasing frequency as the distance from the equator increases. It is believed to be caused by a combination of genetic and environmental factors, with monozygotic concordance at 25%. Overall, multiple sclerosis is a predominantly white matter disease that can have a significant impact on a patient’s quality of life.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 16 - What is a true statement about the prion protein (PrPc)? ...

    Incorrect

    • What is a true statement about the prion protein (PrPc)?

      Your Answer:

      Correct Answer: It can be broken down by protease

      Explanation:

      The prion protein has two forms: the normal form (PrPc) and the infectious form (PrPSc). The normal form can be broken down by proteases, while the infectious form is resistant to proteases.

      Prion Protein and its Role in Disease

      Prion protein is a type of infective agent that is composed of protein. It is made up of proteins called PrP, which exist in two forms: a normal form (PrPC) and an abnormal form (PrPSc). The abnormal form is resistant to protease, which means it cannot be broken down in the body. This abnormal form can change adjacent normal PrPC into the abnormal form, which is how the infection spreads.

      PrPC is a normal component of cell membranes and has an alpha-helical structure. However, in PrPSc, much of the alpha-helical structure is replaced by a beta-sheet structure. This change in structure causes PrPSc to aggregate into plaques in the extracellular space of the central nervous system, disrupting normal tissue structure.

      Prions cause disease by this disruption of normal tissue structure, leading to neurological symptoms and ultimately death. Understanding the structure and behavior of prion proteins is crucial in developing treatments and preventative measures for prion diseases.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 17 - A 50-year-old man presents for a psychiatric assessment. He had a manic episode...

    Incorrect

    • A 50-year-old man presents for a psychiatric assessment. He had a manic episode after several years of being in remission without requiring psychotropic medication. Haloperidol was initiated, and he responded positively. He is now interested in exploring long-term management options.
      He has a history of untreated hypertension, resulting in severe chronic kidney disease.
      What would be the most appropriate choice for long-term management?

      Your Answer:

      Correct Answer: Valproate

      Explanation:

      For the long-term management of mania, NICE (CG185) recommends offering a psychological intervention designed for bipolar disorder to prevent relapse. Additionally, lithium should be offered as the first-line, long-term pharmacological treatment. If lithium is not effective, valproate may be considered as an alternative. If lithium is not well-tolerated of not suitable due to reasons such as the person not agreeing to routine blood monitoring, olanzapine or quetiapine may be considered instead, with quetiapine being a viable option if it has been effective during an episode of mania of bipolar depression. It is important to note that valproate would be the next best option if lithium is contraindicated due to severe renal impairment.

      Renal Impairment and Psychotropic Drugs

      The following table provides recommendations for drug treatment in patients with renal impairment, based on the Maudsley 14th guidelines. When a new drug treatment is required, the suggestions below should be followed.

      Drug Group Recommendation

      Antipsychotics: It is recommended to avoid sulpiride and amisulpride. Otherwise, no agent is clearly preferable to another. For first-generation antipsychotics, haloperidol (2-6 mg/day) is the best choice. For second-generation antipsychotics, olanzapine (5mg/day) is the best choice.

      Antidepressants: No agent is clearly preferable to another. Reasonable choices include sertraline (although there is poor efficacy data in renal disease), citalopram (with care over QTc prolongation), and fluoxetine (with care over long half-life).

      Mood stabilizers: Lithium is nephrotoxic and contraindicated in severe renal impairment. Otherwise, no agent is clearly preferable to another. Valproate of lamotrigine are suggested.

      Anxiolytics: No agent is clearly preferable to another. Lorazepam and zopiclone are suggested.

      Anti-dementia drugs: No agent is clearly preferable to another. Rivastigmine is suggested.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 18 - Which individual delved into the field of medical sociology regarding the concept of...

    Incorrect

    • Which individual delved into the field of medical sociology regarding the concept of 'the sick role'?

      Your Answer:

      Correct Answer: Parson's

      Explanation:

      The Sick Role and Illness Behavior

      Mechanic and Volkart (1961) introduced the term illness behavior to describe how individuals perceive, evaluate, and respond to symptoms of physical dysfunction. Meanwhile, Talcott Parsons (1951) introduced the concept of the sick role as a temporary form of deviant behavior that is medically sanctioned.

      According to Parsons, a sick person experiences conflicting desires to recover from the illness and to enjoy the secondary gains of attention and exemption from normal duties. The sick role is characterized by several rules, including the exemption of the sick person from their normal social roles, which is legitimized by society through the physician. The severity of the illness determines the strength of the exemption.

      Additionally, sick persons are not held responsible for their illnesses, as they are beyond personal control. However, they have a duty to try to get well, as sickness is considered undesirable by society. Seeking competent technical help and cooperating with caregivers are also expected of sick persons.

      In summary, the sick role and illness behavior are important concepts in understanding how individuals respond to physical dysfunction and how society legitimizes and responds to illness.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 19 - From which substance is melatonin produced? ...

    Incorrect

    • From which substance is melatonin produced?

      Your Answer:

      Correct Answer: Serotonin

      Explanation:

      Melatonin: The Hormone of Darkness

      Melatonin is a hormone that is produced in the pineal gland from serotonin. This hormone is known to be released in higher amounts during the night, especially in dark environments. Melatonin plays a crucial role in regulating the sleep-wake cycle and is often referred to as the hormone of darkness.

      The production of melatonin is influenced by the amount of light that enters the eyes. When it is dark, the pineal gland releases more melatonin, which helps to promote sleep. On the other hand, when it is light, the production of melatonin is suppressed, which helps to keep us awake and alert.

      Melatonin is also known to have antioxidant properties and may help to protect the body against oxidative stress. It has been suggested that melatonin may have a role in the prevention of certain diseases, such as cancer and neurodegenerative disorders.

      Overall, melatonin is an important hormone that plays a crucial role in regulating our sleep-wake cycle and may have other health benefits as well.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 20 - Which outcome is most likely to result from the use of interferon α?...

    Incorrect

    • Which outcome is most likely to result from the use of interferon α?

      Your Answer:

      Correct Answer: Depression

      Explanation:

      Prescribing in the Elderly: Iatrogenic Consequences

      Many medications, both prescribed and over-the-counter, can have significant adverse effects in the elderly population. It is important to note that the lists provided below are not exhaustive, and only the most common and important examples are given.

      Medications Linked to Delirium and Other Cognitive Disorders

      Medications are the most common reversible cause of delirium and dementia in the elderly. Many medications can cause cognitive impairment, but the classes of drugs most strongly associated with the development of drug-induced dementia are opioids, benzodiazepines, and anticholinergics.

      According to a systematic review done in 2011 (Clegg, 2011), long-acting benzodiazepines (e.g., diazepam) are more troublesome than those that are shorter-acting. Opioids are associated with an approximately 2-fold increased risk of delirium in medical and surgical patients (Clegg, 2011). Pethidine appears to have a higher risk of delirium compared with other members of the opioid class. This may be because pethidine can accumulate when renal function is impaired and is converted to a metabolite with anticholinergic properties.

      Some antipsychotic drugs have considerable antimuscarinic (anticholinergic) activity (e.g., chlorpromazine and clozapine), which may cause of worsen delirium. Delirium is uncommon in newer antipsychotics (but has been reported).

      Medications Linked to Mood Changes

      The following medications are well known to precipitate mood changes:

      – Centrally-acting antihypertensives (e.g., methyldopa, reserpine, and clonidine) can cause depressive symptoms.
      – Interferon-a is capable of inducing depressive symptoms.
      – Digoxin is capable of inducing depressive symptoms.
      – Corticosteroids can cause depressive, manic, and mixed symptoms with of without psychosis.
      – Antidepressants can precipitate mania.

      Medications Linked to Psychosis

      The following medications are well known to precipitate psychosis:

      – Anti-Parkinson’s Medications (e.g., bromocriptine, amantadine, selegiline, anticholinergics (e.g., trihexyphenidyl, benztropine, benzhexol), and levodopa).
      – Corticosteroids

      Medications Linked to Anxiety

      The following medications are well known to precipitate anxiety:

      – Stimulants
      – β adrenergic inhalers

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 21 - In addition to functioning as a melatonin receptor agonist, what other roles does...

    Incorrect

    • In addition to functioning as a melatonin receptor agonist, what other roles does agomelatine play?

      Your Answer:

      Correct Answer: Selective serotonin-receptor antagonist

      Explanation:

      Agomelatine acts as a melatonin receptor agonist and a selective antagonist of serotonin receptors, without affecting the uptake of serotonin, noradrenaline, of dopamine. Second-generation antipsychotics exhibit some level of dopamine D2 antagonism. Mirtazapine functions as a presynaptic antagonist of alpha-2 adrenoceptors. Reboxetine selectively inhibits the reuptake of noradrenaline. Venlafaxine and duloxetine are recognized as inhibitors of serotonin and noradrenaline reuptake.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 22 - You are seeing a 35-year-old male in your office. He has been referred...

    Incorrect

    • You are seeing a 35-year-old male in your office. He has been referred by his primary care physician due to symptoms of increased appetite, weight gain, excessive sleepiness, feeling physically heavy, and sensitivity to rejection. He asks you about the most effective treatments for his condition. What would be the best response to his question?

      Your Answer:

      Correct Answer: Phenelzine

      Explanation:

      The question pertains to a classic case of atypical depression, which is best treated with phenelzine, a MAOI. While imipramine and other TCAs have some evidence for treating atypical depression, they are not as effective as MAOIs. Nowadays, SSRIs are commonly used as a first-line treatment, but they have a weaker evidence base compared to MAOIs and TCAs. Vortioxetine is a new antidepressant that has complex effects on the 5HT system, but it has not been studied for its efficacy in treating atypical depression. Similarly, venlafaxine has not been studied for this indication either.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 23 - What are the underlying principles of using star charts to address behavioural issues?...

    Incorrect

    • What are the underlying principles of using star charts to address behavioural issues?

      Your Answer:

      Correct Answer: Operant conditioning

      Explanation:

      The Use of Star Charts in Behavioral Management

      Star charts have proven to be effective in managing enuresis, encopresis, and acute phase despondency. In cases of encopresis, the star chart reward system has been successful in about 20 to 30% of cases. The use of a wall chart to graphically depict the time spent off the ventilator each day has also been effective in patients with severe ventilator impairments.

      The reward system in the form of a star chart is a type of positive reinforcement, where behavior is strengthened by the presentation of something pleasant. This is a form of operant conditioning, where the animal is active and learns through action. In contrast, classical conditioning involves passive of restrained animals and the use of conditioned and unconditioned stimuli.

      Social learning theories rely on role modeling, identification, and human interactions. While social learning combines classical and operant conditioning, observation of models may be a major factor in the learning process. Higher order conditioning is another form of classical conditioning, where a conditioned stimulus is paired with another stimulus to produce a further conditioned response.

    • This question is part of the following fields:

      • Basic Psychological Processes
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  • Question 24 - In which of the following conditions are taste hallucinations more likely to occur?...

    Incorrect

    • In which of the following conditions are taste hallucinations more likely to occur?

      Your Answer:

      Correct Answer: Can occur in temporal lobe epilepsy

      Explanation:

      Hallucinations of taste, known as gustatory hallucinations, are characterized by unusual of unpleasant taste perceptions. The mechanism behind this disturbance in taste perception is often challenging to explain. Gustatory hallucinations can manifest in various organic conditions, including epilepsy, dementia, schizophrenia, and depression. Additionally, certain psychotropic medications, such as lithium carbonate, can also cause gustatory hallucinations.

    • This question is part of the following fields:

      • History And Mental State
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  • Question 25 - What screening tool does NICE recommend for identifying alcohol misuse? ...

    Incorrect

    • What screening tool does NICE recommend for identifying alcohol misuse?

      Your Answer:

      Correct Answer: AUDIT

      Explanation:

      Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 26 - A man observes the image of an elderly man in the patterns of...

    Incorrect

    • A man observes the image of an elderly man in the patterns of his coffee grounds. What is the term for this perceptual anomaly?

      Your Answer:

      Correct Answer: Pareidolic illusion

      Explanation:

      Pareidolic illusions are vivid illusions that can occur from indistinct stimuli, such as seeing a face in the clouds. These illusions are a result of fantasy and vivid visual imagery and can intensify with concentration. Affect illusions arise from a particular mood state and disappear with concentration. Autoscopic hallucinations involve seeing oneself, such as in an out-of-body experience. Charles Bonnet syndrome is a type of hallucination that occurs in elderly people with reduced visual acuity. Complete illusions occur in the context of inattention, where an incomplete stimulus is perceived as complete. For more information, refer to Casey PR and Kelly B’s book, Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 27 - Can you provide an example of a drug interaction that affects the way...

    Incorrect

    • Can you provide an example of a drug interaction that affects the way a drug works in the body?

      Your Answer:

      Correct Answer: Competition at a receptor

      Explanation:

      Drug Interactions: Understanding the Different Types

      Drug interactions can occur in different ways, and it is important to understand the different types to avoid potential harm. Pharmacokinetic drug interactions happen when one drug affects the metabolism, absorption, of excretion of another drug. This can be due to enzyme induction of inhibition, changes in gastrointestinal tract motility and pH, chelation, competition for renal tubular transport, of changes in protein binding. On the other hand, pharmacodynamic drug interactions occur when one drug directly alters the effect of another drug. This can happen through synergism, antagonism, of interaction at receptors, such as allosteric modulation. It is important to note that pharmacodynamic drug interactions do not involve any absorption, distribution, metabolism, of excretion processes directly. By understanding the different types of drug interactions, healthcare professionals can better manage patients’ medications and prevent potential adverse effects.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 28 - What is the term used to describe a section of DNA in a...

    Incorrect

    • What is the term used to describe a section of DNA in a gene that does not undergo protein translation?

      Your Answer:

      Correct Answer: Intron

      Explanation:

      Splicing of mRNA

      After the transcription of DNA into mRNA, the mRNA undergoes a crucial process known as splicing. This process involves the removal of certain portions of the mRNA, called introns, leaving behind the remaining portions known as exons. The exons are then translated into proteins. The resulting spliced form of RNA is referred to as mature mRNA. This process of splicing is essential for the proper functioning of genes and the production of functional proteins.

    • This question is part of the following fields:

      • Genetics
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  • Question 29 - You are requested to evaluate a young adult who has ingested a toxic...

    Incorrect

    • You are requested to evaluate a young adult who has ingested a toxic amount of medication. In terms of your evaluation, which of the following statements is accurate?

      Your Answer:

      Correct Answer: If the patient has a family history of suicide they are more likely to die by suicide themselves

      Explanation:

      Risk Factors for Suicide

      A family history of suicide is a significant risk factor for suicide, even if there is no family history of psychiatric disorder. Asking someone about suicidal thoughts does not cause them to have those thoughts, and individuals who self-harm regularly are at a higher risk of suicide. In fact, studies have shown that 1-6% of individuals who present to the hospital after non-fatal self-poisoning of self-injury die by suicide within the first year. It is also important to note that 90% of people who die by suicide have a psychiatric disorder. These risk factors should be taken seriously and addressed in order to prevent suicide.

    • This question is part of the following fields:

      • History And Mental State
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  • Question 30 - Which CNS histopathological characteristic is the most distinctive for prion diseases? ...

    Incorrect

    • Which CNS histopathological characteristic is the most distinctive for prion diseases?

      Your Answer:

      Correct Answer: Spongiform (vacuolation) change

      Explanation:

      The presence of spongiform (vacuolation) change is a highly specific indicator of prion diseases. While neuronal loss and gliosis are common in many CNS disorders, spongiform change is unique to prion diseases. This change is characterized by the appearance of vacuoles in the deep cortical layers, cerebellar cortex, of subcortical grey matter. Scar formation and acute immune responses are associated with reactive proliferation of astrocytes and microglia, respectively. In contrast, Alzheimer’s dementia is characterized by the presence of amyloid plaques.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 31 - What substance acts as a partial agonist on nicotinic receptors? ...

    Incorrect

    • What substance acts as a partial agonist on nicotinic receptors?

      Your Answer:

      Correct Answer: Varenicline

      Explanation:

      Varenicline is a medication that helps people quit smoking by partially activating specific nicotine receptors in the body.

      Mechanisms of Action of Different Drugs

      Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 32 - Which of the options below is not considered as one of Kraepelin's mixed...

    Incorrect

    • Which of the options below is not considered as one of Kraepelin's mixed states?

      Your Answer:

      Correct Answer: Inhibited depression

      Explanation:

      Kraepelin’s Mixed States: A Historical Overview

      Kraepelin’s six types of mixed states were based on various combinations of mood, will, and thought processes. These mixed states are less common than pure mania of pure depression. Dysphoric mania and depressive mixed state are the two types of mixed states that have been reduced over the years. Other terms used to describe mixed states include agitated depression, anxious depression, irritable depression, and mixed hypomania. Despite the reduction in the number of mixed states, they remain a relevant psychopathological syndrome in modern times.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 33 - The shift towards a more typical existence for individuals with developmental disabilities, away...

    Incorrect

    • The shift towards a more typical existence for individuals with developmental disabilities, away from institutionalized care, is known as what?

      Your Answer:

      Correct Answer: Normalisation

      Explanation:

      Normalisation in Learning Disability Care

      Normalisation is a concept that is widely used in the field of learning disability care. It refers to the principles of providing individuals with a life experience that is as normal as possible. This approach is a departure from the traditional model of institutionalised care, which often isolates individuals from the wider community. Normalisation aims to create an environment that is inclusive and supportive, where individuals can participate in everyday activities and have access to the same opportunities as everyone else. By promoting independence and social integration, normalisation helps to improve the quality of life for people with learning disabilities.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 34 - What is the pathway that links the lateral geniculate nucleus to the primary...

    Incorrect

    • What is the pathway that links the lateral geniculate nucleus to the primary visual cortex in the occipital lobe?

      Your Answer:

      Correct Answer: Geniculocalcarine tract

      Explanation:

      White matter is the cabling that links different parts of the CNS together. There are three types of white matter cables: projection tracts, commissural tracts, and association tracts. Projection tracts connect higher centers of the brain with lower centers, commissural tracts connect the two hemispheres together, and association tracts connect regions of the same hemisphere. Some common tracts include the corticospinal tract, which connects the motor cortex to the brainstem and spinal cord, and the corpus callosum, which is the largest white matter fiber bundle connecting corresponding areas of cortex between the hemispheres. Other tracts include the cingulum, superior and inferior occipitofrontal fasciculi, and the superior and inferior longitudinal fasciculi.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 35 - How can a dosette box help the elderly gentleman remember to take his...

    Incorrect

    • How can a dosette box help the elderly gentleman remember to take his medication?

      Your Answer:

      Correct Answer: Mirtazapine

      Explanation:

      Drug Stability

      The stability of drugs can vary greatly, with some medications being unable to be included in compliance aids due to their susceptibility to environmental factors. Certain drugs have a tendency to absorb moisture from the air, rendering them ineffective, with light known to accelerate this process. Examples of drugs that are unsuitable for compliance aids due to their susceptibility to environmental factors include Sodium valproate, Zopiclone, Venlafaxine, Topiramate, Methylphenidate, Mirtazapine, Olanzapine, Amisulpride, and Aripiprazole.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 36 - A child psychologist is conducting an evaluation of a new client who seems...

    Incorrect

    • A child psychologist is conducting an evaluation of a new client who seems to be suppressing of denying some past traumatic events. The psychologist wants to administer a projective personality assessment to the child.
      What would be the most appropriate assessment to use in this situation?

      Your Answer:

      Correct Answer: Holtzman inkblot technique (HIT)

      Explanation:

      Personality assessment can be approached in two ways: objective and projective. Objective assessment involves structured, standardized measurement tools that typically require self-reporting. This approach uses direct questions to gather information about a person’s opinion of themselves. In contrast, projective assessment involves unstructured and often ambiguous stimuli to elicit responses that reveal information about a person’s personality. The Holtzman inkblot technique (HIT) is an example of a projective measure, while the Eysenck personality questionnaire (EPQ), Personality Assessment Inventory (PAI), and Millon Clinical Multiaxial Inventory (MCMI) are all examples of objective measures. The EPQ, PAI, and MCMI all use a true of false self-reporting format to gather information about a person’s personality.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 37 - Depression is classified under which axis of DSM V? ...

    Incorrect

    • Depression is classified under which axis of DSM V?

      Your Answer:

      Correct Answer: Axis I

      Explanation:

      The DSM-5 is a manual published by the American Psychiatric Association that categorizes mental health disorders for children and adults. In the UK, the equivalent is the ICD-10. The DSM-IV organized psychiatric diagnoses into five axes, including clinical syndromes (such as anorexia nervosa and schizophrenia), developmental and personality disorders, physical conditions that contribute to mental illness, psychosocial stressors, and the patient’s level of functioning.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 38 - What is another term for 'intrinsic activity' when referring to drug/receptor interactions? ...

    Incorrect

    • What is another term for 'intrinsic activity' when referring to drug/receptor interactions?

      Your Answer:

      Correct Answer: Efficacy

      Explanation:

      Efficacy, also referred to as intrinsic activity, pertains to a drug’s capacity to produce a reaction upon binding to a receptor.

      Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 39 - What is the most probable reason for the mixed martial artist's motivation to...

    Incorrect

    • What is the most probable reason for the mixed martial artist's motivation to become a champion despite experiencing humiliation from his father as a child?

      Your Answer:

      Correct Answer: Sublimation

      Explanation:

      The man’s mother’s stance against violence prevented him from acting aggressively towards his father. Instead, he found an outlet for his aggression through martial arts, which was deemed socially acceptable. His success as a champion suggests that he sublimated his aggression into a positive pursuit, rather than displacing it onto others, which is a less mature defense mechanism. There is no indication that he repressed his feelings towards his father, as he was able to channel his aggression in a constructive manner.

      Intermediate Mechanism: Rationalisation

      Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

      Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

      Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

      Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 40 - Which of the five major personality traits assesses an individual's concern for and...

    Incorrect

    • Which of the five major personality traits assesses an individual's concern for and ability to understand others?

      Your Answer:

      Correct Answer: Agreeableness

      Explanation:

      Agreeableness pertains to an individual’s prioritization of social harmony, often demonstrated through traits such as generosity, consideration, trust, and helpfulness. Conscientiousness refers to an individual’s level of self-discipline. Extraversion pertains to an individual’s engagement with the external world. Neuroticism describes an individual’s emotional stability, rather than the Freudian concept of neuroticism. Openness to experience pertains to an individual’s inclination towards intellectual curiosity.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 41 - What is the accuracy of psychiatric diagnosis? ...

    Incorrect

    • What is the accuracy of psychiatric diagnosis?

      Your Answer:

      Correct Answer: Is increased by semi-structured interviews

      Explanation:

      Psychiatric diagnosis reliability can be measured through observer and interview methods. With skilled practitioners, psychiatric diagnoses are now as reliable as clinical judgments in other medical fields, and sometimes even more so. To increase reliability and reduce disagreement, structured of standardized interviews can be used, along with definitions for all psychopathology items covered by the interview and operational definitions to ensure consistent diagnoses. The WHO conducted field trials in 1986, which showed almost global acceptability, coverage, and inter-rater reliability of psychiatric diagnostic categories. While reliability and validity are independent, reliability sets a limit on validity. Diagnostic criteria and standardized interview schedules have been proven to increase psychiatric diagnosis reliability.

    • This question is part of the following fields:

      • Assessment
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  • Question 42 - Which structure is most likely to show signs of atrophy in a patient...

    Incorrect

    • Which structure is most likely to show signs of atrophy in a patient with Alzheimer's disease?

      Your Answer:

      Correct Answer: Hippocampus

      Explanation:

      Alzheimer’s disease often results in the shrinkage of the hippocampus, which is a component of the limbic system and is responsible for the formation and retention of long-term memories.

      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.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 43 - A teenager who needs to start an antipsychotic tells you that they are...

    Incorrect

    • A teenager who needs to start an antipsychotic tells you that they are very concerned about the risk of weight gain. You anticipate that they may discontinue the medication if they experience weight gain. What would be the most suitable initial approach to address this concern?

      Your Answer:

      Correct Answer: Aripiprazole

      Explanation:

      Antipsychotic drugs are known to cause weight gain, but some more than others. The reason for this is not due to a direct metabolic effect, but rather an increase in appetite and a decrease in activity levels. The risk of weight gain appears to be linked to clinical response. There are several suggested mechanisms for this, including antagonism of certain receptors and hormones that stimulate appetite. The risk of weight gain varies among different antipsychotics, with clozapine and olanzapine having the highest risk. Management strategies for antipsychotic-induced weight gain include calorie restriction, low glycemic index diet, exercise, and switching to an alternative antipsychotic. Aripiprazole, ziprasidone, and lurasidone are recommended as alternative options. Other options include aripiprazole augmentation, metformin, orlistat, liraglutide, and topiramate.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 44 - Who proposed the Attenuation Theory as an explanation for selective attention? ...

    Incorrect

    • Who proposed the Attenuation Theory as an explanation for selective attention?

      Your Answer:

      Correct Answer: Treisman

      Explanation:

      Selective attention involves filtering external stimuli and assigning meaning to things that should get our attention. Three main models have been proposed: Broadbent’s Filter model, Treisman’s Attenuation Theory, and Deutsch and Deutsch’s Late stage model. Broadbent’s model is an early selection model that filters input based on physical characteristics, while Treisman’s model is an intermediate selection model that uses a leaky filter to weaken some stimuli but allow them through. Deutsch and Deutsch’s model is a late selection model that analyzes input for meaning before filtering occurs. Treisman’s model includes a dictionary unit that emphasizes certain words have lower thresholds for getting our attention, such as our own name.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 45 - Which of the following is linked to losing weight? ...

    Incorrect

    • Which of the following is linked to losing weight?

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 46 - In what circumstances does Lyonization always take place? ...

    Incorrect

    • In what circumstances does Lyonization always take place?

      Your Answer:

      Correct Answer: Klinefelter's syndrome

      Explanation:

      Klinefelter’s syndrome is a condition that occurs when a male has one of more extra copies of the X chromosome in their cells. This extra genetic material interferes with male sexual development, causing the testes to function abnormally and reducing testosterone levels. This can lead to delayed of incomplete puberty, genital abnormalities, gynecomastia, reduced facial and body hair, and infertility. Additionally, individuals with Klinefelter’s syndrome may experience learning disabilities, delayed speech and language development, and a shy personality. The syndrome is typically caused by one extra X chromosome in each cell, but can also be caused by two of three extra X chromosomes. The severity of symptoms increases with the number of extra sex chromosomes. Some individuals with Klinefelter’s syndrome have the extra X chromosome in only some of their cells, which can result in milder symptoms. Lyonization, which occurs when there are multiple X chromosomes in a cell, is present to some degree in all individuals with Klinefelter’s syndrome.

      Lyonization: The Process of X-Inactivation

      The X chromosome is crucial for proper development and cell viability, containing over 1,000 essential genes. However, females carry two copies of the X chromosome, which can result in a potentially toxic double dose of X-linked genes. To address this imbalance, females undergo a process called Lyonization, of X-inactivation, where one of their two X chromosomes is transcriptionally silenced. The silenced X chromosome then condenses into a compact structure known as a Barr body, which remains in a silent state.

      X-inactivation occurs randomly, with no preference for the paternal or maternal X chromosome. It takes place early in embryogenesis, soon after fertilization when the dividing conceptus is about 16-32 cells big. This process occurs in all somatic cells of women, but not in germ cells involved in forming gametes. X-inactivation affects most, but not all, genes on the X chromosome. If a cell has more than two X chromosomes, the extra Xs are also inactivated.

    • This question is part of the following fields:

      • Genetics
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  • Question 47 - You have a female patient in her 30s who is experiencing depression and...

    Incorrect

    • You have a female patient in her 30s who is experiencing depression and you have recommended antidepressant medication. However, she expresses concern about taking any medication that may impact her sexual functioning. Which antidepressant would be the most appropriate for her in this situation?

      Your Answer:

      Correct Answer: Agomelatine

      Explanation:

      Compared to other antidepressants, agomelatine has a lower likelihood of causing sexual dysfunction. This is because other antidepressants can cause various changes in the body, such as sedation, hormonal changes, and disruption of the cholinergic/adrenergic balance, which can lead to sexual dysfunction. Additionally, other antidepressants may inhibit nitric oxide and increase neurotransmission, which can also contribute to sexual dysfunction. However, agomelatine does not act through the serotonergic of alpha adrenergic systems and has a lower propensity for causing these changes, resulting in less sexual dysfunction.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 48 - What does axis 3 of ICD-10 refer to? ...

    Incorrect

    • What does axis 3 of ICD-10 refer to?

      Your Answer:

      Correct Answer: Current psychosocial problems

      Explanation:

      The multi-axial version of ICD-10 expands the evaluation of the patient’s condition by utilizing three axes:
      Axis 1 specifies the mental disorder, encompassing personality disorder and mental handicap
      Axis 2 specifies the level of impairment, and
      Axis 3 specifies existing psychosocial difficulties.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 49 - Which medication is known to cause nephrogenic diabetes insipidus as a significant adverse...

    Incorrect

    • Which medication is known to cause nephrogenic diabetes insipidus as a significant adverse reaction?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      The exact reason for the development of polyuria and polydipsia (nephrogenic diabetes insipidus) as a side effect of lithium treatment is not fully understood, but it is believed to be linked to the impact of lithium on ion transportation.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 50 - In what century did psychiatry become established as a distinct medical field? ...

    Incorrect

    • In what century did psychiatry become established as a distinct medical field?

      Your Answer:

      Correct Answer: 18th century

      Explanation:

      Psychiatry emerged as a distinct medical field in the late 1700s, leading to the establishment of specialized asylums designed to provide therapeutic care for individuals with mental illnesses who were previously confined in institutions.

    • This question is part of the following fields:

      • History Of Psychiatry
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  • Question 51 - A teenager who is not compliant with their medicine says they just forget...

    Incorrect

    • A teenager who is not compliant with their medicine says they just forget to take it. The therapist points out that when they stop the medication they end up missing school and social activities. Which technique is the therapist using?

      Your Answer:

      Correct Answer: Confrontation

      Explanation:

      Interview Techniques: Confrontation

      Confrontation is a technique that can be employed during patient interviews to draw their attention to a particular issue. However, it is crucial to use this technique with care as it can potentially lead to the patient becoming defensive of hostile. Therefore, it is essential to approach confrontation tactfully and with sensitivity. By doing so, the interviewer can effectively communicate their concerns to the patient without causing any unnecessary tension of conflict. Proper use of confrontation can help patients recognize and address problematic behaviors of attitudes, leading to positive outcomes in their treatment.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 52 - The theorist who proposed the existence of the language acquisition device (LAD) in...

    Incorrect

    • The theorist who proposed the existence of the language acquisition device (LAD) in humans is:

      Your Answer:

      Correct Answer: Chomsky

      Explanation:

      Chomsky is known for his nativist theory and introduction of the language acquisition device (LAD) in the 1960s. Empiricism theory is often attributed to Locke, while parsing was described by Saffran. Skinner is associated with behaviourism, and Werker studied how infants distinguish between phonemes.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 53 - Which of the options works by temporarily blocking the activity of cholinesterase through...

    Incorrect

    • Which of the options works by temporarily blocking the activity of cholinesterase through reversible inhibition?

      Your Answer:

      Correct Answer: Rivastigmine

      Explanation:

      Mechanisms of Action of Different Drugs

      Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 54 - An example of a delusional belief held by a middle-aged woman who thinks...

    Incorrect

    • An example of a delusional belief held by a middle-aged woman who thinks that the government is communicating with her through television advertisements.

      Your Answer:

      Correct Answer: Delusion of reference

      Explanation:

      The patient has a false belief that others are manipulating situations of occurrences to communicate with them, which is known as a delusion of reference.

    • This question is part of the following fields:

      • History And Mental State
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  • Question 55 - After achieving a stable dose of lithium, what is the recommended frequency for...

    Incorrect

    • After achieving a stable dose of lithium, what is the recommended frequency for monitoring lithium levels?

      Your Answer:

      Correct Answer: Every 3-6 months

      Explanation:

      It is common for patients taking lithium to be inadequately monitored, which has prompted NICE and the National Patient Safety Agency (NPSA) to issue guidance on the matter. This topic is often tested in exams. According to NICE (CKS), lithium blood levels should be checked weekly until they become stable, and then every 3 months once they are stable. The levels should be taken 12 hours after the dose. Maudsley (13th) recommends checking levels every 6 months, but more frequent monitoring is necessary for those taking interacting drugs, the elderly, and those with established renal impairment of other relevant physical illness. The BNF recommends weekly monitoring until stable, and then every 3 months for the first year, followed by every 6 months thereafter. Patients should have their thyroid and renal function checked every 6 months, and they should be provided with an information booklet, alert card, and record book.

      Lithium – Pharmacology

      Pharmacokinetics:
      Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

      Ebstein’s:
      Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

      Contraindications:
      Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

      Side-effects:
      Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

      Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

      Lithium-induced diabetes insipidus:
      Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

      Toxicity:
      Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

      Pre-prescribing:
      Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Monitoring:
      Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 56 - The psychiatrist is using the technique of direct questioning to gather information about...

    Incorrect

    • The psychiatrist is using the technique of direct questioning to gather information about the patient's alcohol consumption.

      Example of a similar question with different wording and age:

      After a teenager mentions that they smoke cigarettes, the counselor asks, How many packs of cigarettes do you smoke in a week? One? Two?

      The counselor is using the technique of direct questioning to gather information about the teenager's smoking habits.

      Your Answer:

      Correct Answer: Symptom exaggeration

      Explanation:

      Symptom exaggeration is a method of suggesting a behavior that is more problematic than expected to help the patient feel less guilty and provide a more truthful response. Confrontation involves the doctor pointing out something that the patient may be denying of missing. Clarification is used to clarify something the patient has said. Open-ended questions encourage the patient to respond in their own words and cannot be answered with a simple yes of no. Validation is used to make the patient’s thoughts, feelings, of behaviors seem more acceptable by normalizing them.

    • This question is part of the following fields:

      • History And Mental State
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  • Question 57 - This stage of reasoning illustrates the conventional stage of moral development, where individuals...

    Incorrect

    • This stage of reasoning illustrates the conventional stage of moral development, where individuals make decisions based on social norms and expectations:

      Your Answer:

      Correct Answer: Good Boy/Nice Girl orientation

      Explanation:

      The child’s reasoning demonstrates an understanding that actions are evaluated as either positive of negative by others, and that the appropriate course of action is one that is deemed positive (of not negative) by the society.

      Kohlberg’s Six Stages of Moral Development

      Kohlberg’s theory of moral development consists of six stages that can be categorized into three levels. The first level is the preconventional stage, which is characterized by obedience and punishment orientation, where the focus is on the direct consequences of actions and unquestioning deference to power. The second stage is the self-interest orientation, where right behavior is defined purely by what is in the individual’s own interest.

      The second level is the conventional stage, which is characterized by interpersonal accord and conformity, where the focus is on how the individual will appear to others. The behavior should accord with a consensus view on what is good. The second stage is the authority and social order obedience driven, where what is lawful is judged to be morally right. Right behavior is dictated by societal rules, and there is a greater respect for social order and the need for laws.

      The third level is the postconventional stage, which is characterized by the social contract orientation, where individual rights determine behavior. The individual views laws and rules as flexible tools for improving human purposes. The fourth stage is the universal ethical principles orientation, where the right action is the one that is consistent with abstract reasoning using universal ethical principles.

      It is important to note that the age ranges for Kohlberg’s developmental stages are rough guides, and sources vary widely. Kohlberg developed his stage theory following an experiment he conducted on 72 boys aged 10-16. However, the theory is criticized as sexist as it only included boys.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 58 - A 35-year-old man with a history of schizophrenia exhibits significant thought disorder and...

    Incorrect

    • A 35-year-old man with a history of schizophrenia exhibits significant thought disorder and unpredictable conduct. He is presently residing in a shelter for the homeless and has been observed to have inadequate self-maintenance and social abilities. Based on this information, which subtype of schizophrenia according to ICD-10 is indicated?

      Your Answer:

      Correct Answer: Hebephrenic

      Explanation:

      Hebephrenic schizophrenia is a type of schizophrenia that is classified in the ICD-10 as having a greater emphasis on thought disorder than hallucinations, with erratic of disorganized behavior being prominent. The DSM-IV equivalent is disorganized schizophrenia. Catatonic schizophrenia is characterized by abnormalities in psychomotor function. Paranoid schizophrenia is characterized by paranoid delusions and auditory hallucinations. Simple schizophrenia is not a suitable option because it is a subtype of schizophrenia that is characterized by a decline in functioning as the only clear symptom. Undifferentiated schizophrenia refers to a presentation of schizophrenia that does not fit into a specific subtype.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 59 - Which scale is the most useful for assessing the symptoms that occur when...

    Incorrect

    • Which scale is the most useful for assessing the symptoms that occur when discontinuing antidepressants?

      Your Answer:

      Correct Answer: DESS

      Explanation:

      The DESS scale is a comprehensive rating system consisting of 43 items that assess a wide range of symptoms that may arise during discontinuation.

      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).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 60 - What is the OTC medication that poses the highest risk of a severe...

    Incorrect

    • What is the OTC medication that poses the highest risk of a severe interaction with an MAOI antidepressant?

      Your Answer:

      Correct Answer: Chlorphenamine

      Explanation:

      Chlorphenamine, also known as Piriton, is classified as a first-generation antihistamine that functions by obstructing the H1 receptor. This sedative antihistamine is utilized to treat allergic conditions like hay fever. Additionally, it is present in certain cough medicines as it reduces the production of mucus.

      MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

      First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

      MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

      The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

      Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

      Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 61 - What is the term used in classical conditioning to describe an unlearned, inborn...

    Incorrect

    • What is the term used in classical conditioning to describe an unlearned, inborn reaction to an unconditioned stimulus?

      Your Answer:

      Correct Answer: An unconditioned response

      Explanation:

      Classical Conditioning: A Learning Theory by Ivan Pavlov

      Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.

      Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 62 - At what threshold does the membrane potential of a cell need to reach...

    Incorrect

    • At what threshold does the membrane potential of a cell need to reach in order to trigger an action potential?

      Your Answer:

      Correct Answer: -55 mV

      Explanation:

      Understanding Action Potentials in Neurons and Muscle Cells

      The membrane potential is a crucial aspect of cell physiology, and it exists across the plasma membrane of most cells. However, in neurons and muscle cells, this membrane potential can change over time. When a cell is not stimulated, it is in a resting state, and the inside of the cell is negatively charged compared to the outside. This resting membrane potential is typically around -70mV, and it is maintained by the Na/K pump, which maintains a high concentration of Na outside and K inside the cell.

      To trigger an action potential, the membrane potential must be raised to around -55mV. This can occur when a neurotransmitter binds to the postsynaptic neuron and opens some ion channels. Once the membrane potential reaches -55mV, a cascade of events is initiated, leading to the opening of a large number of Na channels and causing the cell to depolarize. As the membrane potential reaches around +40 mV, the Na channels close, and the K gates open, allowing K to flood out of the cell and causing the membrane potential to fall back down. This process is irreversible and is critical for the transmission of signals in neurons and the contraction of muscle cells.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 63 - Which of the options experiences the lowest level of metabolism in the liver?...

    Incorrect

    • Which of the options experiences the lowest level of metabolism in the liver?

      Your Answer:

      Correct Answer: Gabapentin

      Explanation:

      Gabapentin, lithium, and topiramate require minimal of no hepatic metabolism, allowing them to be excreted without undergoing significant liver alteration.

      Drug Clearance: Understanding the Rate of Drug Removal from the Body

      Drug clearance refers to the efficiency of drug removal from the plasma, and is measured as the volume of plasma cleared of a drug over a specific time period. The unit of measurement for drug clearance is volume per time. Clearance of a drug involves both metabolism and excretion. When drug intake equals clearance, it is referred to as a steady state, which is usually achieved by 4.5 half-lives. The time taken to reach steady state depends on the half-life of the drug.

      There are two main types of clearance: hepatic and renal. Hepatic clearance involves the conversion of the parent drug into a different chemical entity by the liver enzymes, while renal clearance involves the removal of the drug from the plasma into the urine. The clearance of a drug can take one of two forms: zero and first-order kinetics. In zero-order reactions, the clearance of a drug is constant and not related to the concentration of the drug in the plasma. This type of reaction is typically found when the material needed for the reaction to proceed (e.g. enzyme) is saturated. Ethanol and Phenytoin are good examples of this.

      Most drugs tend to follow first-order reactions, where the clearance is related to the concentration of the drug in the plasma. The half-life of a drug is the time taken for its concentration to fall by half. In first-order reactions, this is constant. In zero-order reactions, it gets progressively shorter.

      It is important to note that elimination and clearance are not the same. Elimination is the irreversible removal of the drug from the body, while clearance is a theoretical volume of blood that is cleared of the drug per unit of time, which is independent of the drug dose of concentration. Understanding drug clearance is crucial in determining the appropriate dosing regimen for a drug.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 64 - From which amino acids are the catecholamines derived? ...

    Incorrect

    • From which amino acids are the catecholamines derived?

      Your Answer:

      Correct Answer: Tyrosine

      Explanation:

      Catecholamines are a group of chemical compounds that have a distinct structure consisting of a benzene ring with two hydroxyl groups, an intermediate ethyl chain, and a terminal amine group. These compounds play an important role in the body and are involved in various physiological processes. The three main catecholamines found in the body are dopamine, adrenaline, and noradrenaline. All of these compounds are derived from the amino acid tyrosine. Overall, catecholamines are essential for maintaining proper bodily functions and are involved in a wide range of physiological processes.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 65 - Which of the following statements most accurately defines tangentiality? ...

    Incorrect

    • Which of the following statements most accurately defines tangentiality?

      Your Answer:

      Correct Answer: It is a disorder of the form of thought

      Explanation:

      Karl Jaspers, a German psychiatrist and philosopher, first described tangentiality as a formal thought disorder where the patient deviates from the topic at hand and introduces new but related words. Although the examiner can usually follow the patient’s train of thought, the patient often loses track of the interviewer’s question. While tangentiality is not specific to any particular mental disorder, it can be present in conditions such as mania, hypomania, and schizophrenia. Other examples of formal thought disorder include loosening of associations, circumstantiality, thought block, perseveration, and flight of ideas.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 66 - As the liaison psychiatry doctor on-call, you are requested to assess a 42-year-old...

    Incorrect

    • As the liaison psychiatry doctor on-call, you are requested to assess a 42-year-old male patient in the early hours of the morning on a general medical ward. He was admitted with pancreatitis twelve hours ago and has been medically cleared. The patient has no significant past medical of psychiatric history, but he has become paranoid and delusional, believing that there are bugs crawling under his skin. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Delirium tremens (DTs)

      Explanation:

      The presence of acute psychosis, visual hallucinations, and formications in an individual with pancreatitis likely caused by alcohol suggests severe alcohol withdrawal of DTs, which should have been prevented with prophylactic treatment using Librium (chlordiazepoxide). Schizophrenia is improbable due to the patient’s age, sudden onset of symptoms, and lack of first rank symptoms. Korsakoff’s of amnesic syndrome typically precedes Wernicke’s, and parenteral Pabrinex (thiamine) is usually administered prophylactically. Since the patient was an inpatient, it is unlikely that he had access to illicit drugs, and the absence of post-seizure psychosis rules out that possibility.

    • This question is part of the following fields:

      • Diagnosis
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  • Question 67 - What is the most dependable indicator of the sudden and unforeseen demise of...

    Incorrect

    • What is the most dependable indicator of the sudden and unforeseen demise of an individual with epilepsy?

      Your Answer:

      Correct Answer: Frequent generalised tonic-clonic seizures

      Explanation:

      SUDEP, of sudden unexpected death in epilepsy, is a condition where patients with epilepsy die suddenly and unexpectedly without any apparent cause. It is estimated to be responsible for 20-30% of deaths in epilepsy patients. The condition is more common in adults than in children, affecting 1 in 1,000 adults with epilepsy per year. The main risk factor for SUDEP is having active generalised tonic clonic seizures (GTCS), and better control of these seizures through improved compliance can reduce the risk of SUDEP. Other risk factors include nocturnal seizures, lamotrigine, never having been treated with an antiepileptic drug, intellectual disability, and male sex. However, the evidence for these factors is considered low. Autopsy findings in SUDEP cases do not reveal any specific cause of death, but obstruction of the airways and cardiorespiratory events such as arrhythmia are thought to be possible mechanisms.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 68 - What is a true statement about the Brief Psychosis Rating Scale (BPRS)? ...

    Incorrect

    • What is a true statement about the Brief Psychosis Rating Scale (BPRS)?

      Your Answer:

      Correct Answer: It can be used for patients who are unable to read of write

      Explanation:

      Brief Psychiatric Rating Scale: An Instrument for Evaluating Psychopathology in Psychiatric Patients

      The Brief Psychiatric Rating Scale (BPRS) is a widely used tool for assessing psychopathology in psychiatric patients. It was developed in the 1960s by Overall and Gorham, using factor analysis, to evaluate the severity of schizophrenic states and provide clinicians with a quick way to assess patient change. Initially, the BPRS consisted of 16 items, but two more items were added to create the standard 18-item version. Later, an expanded 24-item version was introduced to measure additional aspects of schizophrenia, such as bizarre behavior, self-neglect, suicidality, elevated mood, motor hyperactivity, and distractibility.

      The BPRS is rated by a clinician, who assesses each item on a 7-point scale of severity. Higher scores indicate greater severity of symptoms. The assessment relies on a combination of self-report and observation. Several variables are rated based on observation, while the rest are assessed through a short interview. The total score severity, using the 18-item version, has been estimated as mildly ill (31), moderately ill (41), and markedly ill (53). The administration of the BPRS can take 10-40 minutes, and versions have been validated for use in both children and older adults. As it is clinician-administered, the BPRS does not require patients to be able to read of write.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 69 - What should be avoided in individuals with hepatic impairment? ...

    Incorrect

    • What should be avoided in individuals with hepatic impairment?

      Your Answer:

      Correct Answer: Duloxetine

      Explanation:

      Duloxetine undergoes hepatic metabolism and its clearance is significantly decreased even in cases of mild impairment. There have been documented cases of hepatocellular injury and, although rare, jaundice. A single case of fulminant hepatic failure has also been reported. Therefore, individuals with hepatic impairment should not take duloxetine as it is contraindicated (as stated in the Maudsley 14th Ed).

      Hepatic Impairment: Recommended Drugs

      Patients with hepatic impairment may experience reduced ability to metabolize drugs, toxicity, enhanced dose-related side effects, reduced ability to synthesize plasma proteins, and elevated levels of drugs subject to first-pass metabolism due to reduced hepatic blood flow. The Maudsley Guidelines 14th Ed recommends the following drugs for patients with hepatic impairment:

      Antipsychotics: Paliperidone (if depot required), Amisulpride, Sulpiride

      Antidepressants: Sertraline, Citalopram, Paroxetine, Vortioxetine (avoid TCA and MAOI)

      Mood stabilizers: Lithium

      Sedatives: Lorazepam, Oxazepam, Temazepam, Zopiclone 3.75mg (with care)

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 70 - In considering whether it could be right to cheat on a test, a...

    Incorrect

    • In considering whether it could be right to cheat on a test, a high school student says that they feel it would be wrong because they believe the social effect would be to reduce the trust the teacher has in students. Another student says he believes that this would increase trust in students instead.

      What moral framework are both students using?

      Your Answer:

      Correct Answer: Utilitarian

      Explanation:

      The two main ethical approaches in philosophy are teleological ethics, which focuses on the end result, and deontological ethics, which focuses on an individual’s actions being morally right regardless of the end result. In medicine, deontology is patient-centered, while utilitarianism is society-centered. Deontological ethics judges the moral status of actions according to rules of principles, such as the duty not to harm the patient versus the duty to help them. Kantian ethics is a strict form of deontological ethics that emphasizes behaving as though one’s behavior is creating a universal ethical rule. Utilitarianism is a teleological approach that prioritizes the action that leads to the greatest happiness of the greatest number, regardless of how it is brought about. In medicine, autonomy is one of four ethical principles, along with beneficence, non-maleficence, and justice, that enable patients to choose their own treatment and ensure fairness and equality.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 71 - What is the likely diagnosis when a patient exhibits a normal accommodation reflex...

    Incorrect

    • What is the likely diagnosis when a patient exhibits a normal accommodation reflex but an absent light reflex during a pupil examination?

      Your Answer:

      Correct Answer: Argyll Robertson pupil

      Explanation:

      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.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 72 - A physician declines to administer clozapine to a middle-aged man with treatment-resistant schizophrenia...

    Incorrect

    • A physician declines to administer clozapine to a middle-aged man with treatment-resistant schizophrenia due to his previous history of developing neutropenia when he was first prescribed the medication. Which ethical principle is being upheld in this scenario?

      Your Answer:

      Correct Answer: Non-maleficence

      Explanation:

      Healthcare Ethics and Conflicting Principles

      British physician Thomas Percival is credited with developing the first modern code of healthcare ethics, which prioritizes the principle of non-maleficence. This principle dictates that a clinician’s primary obligation is to avoid causing harm to the patient, even if it means overriding the patient’s autonomy. This idea has been echoed in classical medical writings and is a fundamental rule in common morality.

      In the given scenario, the clinician chooses not to prescribe clozapine, which is likely to cause neutropenia, in order to avoid causing harm to the patient. This decision is in line with the principle of non-maleficence.

      However, the principle of autonomy recognizes an individual’s right to self-determination, which can sometimes conflict with the principles of beneficence and non-maleficence. The principle of beneficence requires clinicians to act in the patient’s best interest and prevent harm.

      Teleology is an ethical theory that evaluates actions based on their final outcome of causality.

    • This question is part of the following fields:

      • Basic Ethics And Philosophy Of Psychiatry
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  • Question 73 - Which statement accurately describes Neuroleptic Malignant Syndrome (NMS)? ...

    Incorrect

    • Which statement accurately describes Neuroleptic Malignant Syndrome (NMS)?

      Your Answer:

      Correct Answer: NMS can be caused by antidepressants

      Explanation:

      If a patient develops NMS, they may still require antipsychotic medication. However, it is recommended to stop antipsychotics for at least 5 days, and ideally longer. When restarting antipsychotics, it should be done slowly and at low doses, with close monitoring of blood pressure and temperature.

      Anticholinergic drugs are believed to worsen NMS, possibly due to their effect on reducing sweating and exacerbating hyperthermia. However, there is no direct causal relationship between anticholinergics and NMS.

      In cases where an alternative antipsychotic is needed, those with low dopamine affinity should be considered. These include clozapine, quetiapine, and aripiprazole.

      Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyper-reflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 74 - Which syndrome would you suspect if a man tells his GP that he...

    Incorrect

    • Which syndrome would you suspect if a man tells his GP that he believes his wife is having an affair, but his wife denies it and expresses worry about his mental well-being?

      Your Answer:

      Correct Answer: Othello

      Explanation:

      Types of Delusions

      Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:

      – Folie a deux: a shared delusion between two or more people
      – Grandiose: belief that one has special powers, beliefs, of purpose
      – Hypochondriacal: belief that something is physically wrong with the patient
      – Ekbom’s syndrome: belief that one has been infested with insects
      – Othello syndrome: belief that a sexual partner is cheating on them
      – Capgras delusion: belief that a person close to them has been replaced by a double
      – Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
      – Syndrome of subjective doubles: belief that doubles of him/her exist
      – Lycanthropy: belief that one has been transformed into an animal
      – De Clérambault’s syndrome: false belief that a person is in love with them
      – Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
      – Referential: belief that others/TV/radio are speaking directly to of about the patient
      – Delusional perception: belief that a normal percept (product of perception) has a special meaning
      – Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.

      Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 75 - What is accurate about the historical categorization of autism? ...

    Incorrect

    • What is accurate about the historical categorization of autism?

      Your Answer:

      Correct Answer: The diagnosis of Asperger disorder first appeared in the DSM-IV

      Explanation:

      Autism: A Brief History

      The term autism was first coined in 1911 by Eugen Bleuler to describe individuals with schizophrenia who had cut themselves off as much as possible from any contact with the external world. In 1926, Grunya Sukhareva attempted to delineate autism spectrum disorders as distinct diagnostic entities, referring to them as schizoid personality disorder. However, her work remained largely unknown until 1996.

      The first widely publicized use of the term autism to describe a distinct condition was in 1943 by Leo Kanner, who referred to it as autistic disturbance of affective contact. Kanner suggested that autism may be a manifestation of childhood schizophrenia and that it was characterized by an inability to related to themselves in the ordinary way to people and situations from the beginning of life. In 1944, Hans Asperger published descriptions of four cases of a condition he termed der autistichen psychopathie, which he regarded as a limitation of social relationships.

      In 1980, infantile autism was included in the DSM-III under a new category of pervasive developmental disorders. Lorna Wing redefined Asperger Syndrome in 1981, proposing a triad of impairments in social interaction, communication, and imaginative activities. In 2000, the DSM-IV utilized the umbrella category of pervasive developmental disorders, with five main subcategories. Finally, in 2013, the DSM-5 combined the subcategories into a single label of autism spectrum disorder, asserting that autism is a single disorder on a wide spectrum.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 76 - Among the given medications, which one is the most probable cause of delirium?...

    Incorrect

    • Among the given medications, which one is the most probable cause of delirium?

      Your Answer:

      Correct Answer: Pethidine

      Explanation:

      Prescribing in the Elderly: Iatrogenic Consequences

      Many medications, both prescribed and over-the-counter, can have significant adverse effects in the elderly population. It is important to note that the lists provided below are not exhaustive, and only the most common and important examples are given.

      Medications Linked to Delirium and Other Cognitive Disorders

      Medications are the most common reversible cause of delirium and dementia in the elderly. Many medications can cause cognitive impairment, but the classes of drugs most strongly associated with the development of drug-induced dementia are opioids, benzodiazepines, and anticholinergics.

      According to a systematic review done in 2011 (Clegg, 2011), long-acting benzodiazepines (e.g., diazepam) are more troublesome than those that are shorter-acting. Opioids are associated with an approximately 2-fold increased risk of delirium in medical and surgical patients (Clegg, 2011). Pethidine appears to have a higher risk of delirium compared with other members of the opioid class. This may be because pethidine can accumulate when renal function is impaired and is converted to a metabolite with anticholinergic properties.

      Some antipsychotic drugs have considerable antimuscarinic (anticholinergic) activity (e.g., chlorpromazine and clozapine), which may cause of worsen delirium. Delirium is uncommon in newer antipsychotics (but has been reported).

      Medications Linked to Mood Changes

      The following medications are well known to precipitate mood changes:

      – Centrally-acting antihypertensives (e.g., methyldopa, reserpine, and clonidine) can cause depressive symptoms.
      – Interferon-a is capable of inducing depressive symptoms.
      – Digoxin is capable of inducing depressive symptoms.
      – Corticosteroids can cause depressive, manic, and mixed symptoms with of without psychosis.
      – Antidepressants can precipitate mania.

      Medications Linked to Psychosis

      The following medications are well known to precipitate psychosis:

      – Anti-Parkinson’s Medications (e.g., bromocriptine, amantadine, selegiline, anticholinergics (e.g., trihexyphenidyl, benztropine, benzhexol), and levodopa).
      – Corticosteroids

      Medications Linked to Anxiety

      The following medications are well known to precipitate anxiety:

      – Stimulants
      – β adrenergic inhalers

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 77 - A parent is worried about their 30-month-old toddler's language skills. What is the...

    Incorrect

    • A parent is worried about their 30-month-old toddler's language skills. What is the expected minimum number of words at this age?

      Your Answer:

      Correct Answer: 240

      Explanation:

      Delayed language development is often linked to various factors, such as being male, belonging to a larger family, coming from a lower social class (IV and V), and experiencing neglect.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 78 - Which study focused on men who participated in sexual activities in public restrooms?...

    Incorrect

    • Which study focused on men who participated in sexual activities in public restrooms?

      Your Answer:

      Correct Answer: Tearoom study

      Explanation:

      Controversial studies in psychiatry have been a popular topic in exams. One such study was the Willowbrook School Study, where healthy children with learning difficulties were inoculated with hepatitis to assess the potential of gamma globulin to treat the disorder. Beecher’s study listed over 20 cases of mainstream research where subjects were experimented on without being fully informed of the risks. The Tuskegee syphilis experiment followed impoverished African-American sharecroppers with syphilis, and a significant proportion did not receive available treatment. Stanford’s prison experiment created a simulated prison environment where participants became their assigned roles, with guards becoming harsh and cruel to prisoners. The Tearooms Study involved Humphreys pretending to be a ‘watch queen’ to study men who have sex in public toilets, raising the issue of informed consent. Milgram’s Study investigated authority and obedience, where participants administered fake shocks to a confederate, with 30 participants continuing to administer shocks until 450 volts was reached. The Rosenhan experiment involved pseudopatients presenting themselves at institutions with the same symptoms and being admitted and diagnosed with serious mental disorders, leading to deinstitutionalisation.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 79 - Which of the following is not a visible characteristic observed in Alzheimer's disease...

    Incorrect

    • Which of the following is not a visible characteristic observed in Alzheimer's disease at a macroscopic level?

      Your Answer:

      Correct Answer: Gliosis

      Explanation:

      Gliosis is a discovery that can only be observed under a microscope.

      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.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 80 - Which processes involve the activation of incentive salience? ...

    Incorrect

    • Which processes involve the activation of incentive salience?

      Your Answer:

      Correct Answer: Grief

      Explanation:

      Understanding Incentive Salience and its Role in Addiction and Grief

      Incentive salience is a process that drives the brain to desire certain things, such as drugs, and is mediated by mesolimbic dopamine systems. This process is separate from the experience of pleasure, and a person can want something they don’t necessarily like. Desire is amplified by brain states that heighten dopamine reactivity, such as stress, emotional excitement, relevant appetites, of intoxication. This state-dependent amplification of incentive salience is one reason why many addicts find it difficult to stop at just one hit.

      Interestingly, grief has been hypothesized to be underpinned by a very similar process as drug addiction, referred to as the ‘incentive salience theory of grief’. Understanding the distinction between liking and wanting can help us better understand addiction and grief, and how the brain processes these experiences.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 81 - What is the accuracy of the dopamine hypothesis in explaining schizophrenia? ...

    Incorrect

    • What is the accuracy of the dopamine hypothesis in explaining schizophrenia?

      Your Answer:

      Correct Answer: Cannabinoid agonists have been shown in animals to increase striatal dopamine release

      Explanation:

      The Dopamine Hypothesis is a theory that suggests that dopamine and dopaminergic mechanisms are central to schizophrenia. This hypothesis was developed based on observations that antipsychotic drugs provide at least some degree of D2-type dopamine receptor blockade and that it is possible to induce a psychotic episode in healthy subjects with pharmacological dopamine agonists. The hypothesis was further strengthened by the finding that antipsychotic drugs’ clinical effectiveness was directly related to their affinity for dopamine receptors. Initially, the belief was that the problem related to an excess of dopamine in the brain. However, later studies showed that the relationship between hypofrontality and low cerebrospinal fluid (CSF) dopamine metabolite levels indicates low frontal dopamine levels. Thus, there was a move from a one-sided dopamine hypothesis explaining all facets of schizophrenia to a regionally specific prefrontal hypodopaminergia and a subcortical hyperdopaminergia. In summary, psychosis appears to result from excessive dopamine activity in the striatum, while the negative symptoms seen in schizophrenia appear to result from too little dopamine activity in the frontal lobe. Antipsychotic medications appear to help by countering the effects of increased dopamine by blocking postsynaptic D2 receptors in the striatum.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 82 - A 35-year-old man was at a concert when a firework exploded nearby. He...

    Incorrect

    • A 35-year-old man was at a concert when a firework exploded nearby. He was standing at the time and the force of the blast threw him to the ground. He suffered a broken arm and multiple cuts. Several people were killed and many others were injured.
      After four months, he experiences nightmares about the incident, struggles to sleep, has avoided going to concerts since, and jumps at sudden sounds. He often finds himself unable to stop thinking about what happened.
      What is the probable diagnosis?

      Your Answer:

      Correct Answer: Post-traumatic stress disorder

      Explanation:

      Post-traumatic stress disorder (PTSD) is a condition that develops in response to an exceptionally threatening of catastrophic event of situation, such as the one described above. It is only diagnosed if symptoms arise within six months of the traumatic event. The symptoms of PTSD can be categorized into three groups: re-experiencing the traumatic event (such as through nightmares of vivid thoughts), persistent avoidance of stimuli associated with the trauma, and persistent symptoms of increased arousal (such as difficulty sleeping of concentrating).

      Agoraphobia is a fear of being in situations of places from which escape is difficult, leading to avoidance of many situations and confinement to the home. This fear is typically triggered by situations such as crowds, public places, of traveling alone of away from home.

      Generalized anxiety disorder is characterized by persistent anxiety that is not limited to any specific environmental circumstance. To receive this diagnosis, a patient must experience symptoms of anxiety on most days for several weeks of months, with evidence of impairment in important areas of functioning. However, this diagnosis is not appropriate for the scenario described above, as the anxiety is related to a specific event of trigger.

      Panic disorder involves sudden onset of severe anxiety, with at least three panic attacks experienced over a three-week period. Symptoms may include sweating, palpitations, shortness of breath, nausea, trembling, chest pain of discomfort, dizziness of lightheadedness, chills of hot flushes, fear of losing control of dying, paraesthesia, feeling of choking, and derealization or depersonalization.

      Social phobia is characterized by a marked fear of social situations in which embarrassment may occur, leading to avoidance of these situations.

    • This question is part of the following fields:

      • Diagnosis
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  • Question 83 - Which medication has been associated with the occurrence of extrapyramidal side effects? ...

    Incorrect

    • Which medication has been associated with the occurrence of extrapyramidal side effects?

      Your Answer:

      Correct Answer: Fluoxetine

      Explanation:

      EPSEs have been linked to the use of fluoxetine, and all of the treatment options are utilized to address them.

      Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 84 - What is the most appropriate term to describe the sequence of events that...

    Incorrect

    • What is the most appropriate term to describe the sequence of events that occurred when a man experienced chest pain at work, was taken to the hospital, received blood tests and an ECG, was prescribed medication, and signed off work for a month by a doctor?

      Your Answer:

      Correct Answer: Sick role

      Explanation:

      There is no indication of feigning symptoms for personal benefit.

      The Sick Role and Illness Behavior

      Mechanic and Volkart (1961) introduced the term illness behavior to describe how individuals perceive, evaluate, and respond to symptoms of physical dysfunction. Meanwhile, Talcott Parsons (1951) introduced the concept of the sick role as a temporary form of deviant behavior that is medically sanctioned.

      According to Parsons, a sick person experiences conflicting desires to recover from the illness and to enjoy the secondary gains of attention and exemption from normal duties. The sick role is characterized by several rules, including the exemption of the sick person from their normal social roles, which is legitimized by society through the physician. The severity of the illness determines the strength of the exemption.

      Additionally, sick persons are not held responsible for their illnesses, as they are beyond personal control. However, they have a duty to try to get well, as sickness is considered undesirable by society. Seeking competent technical help and cooperating with caregivers are also expected of sick persons.

      In summary, the sick role and illness behavior are important concepts in understanding how individuals respond to physical dysfunction and how society legitimizes and responds to illness.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 85 - Who was the originator of the term 'stigma'? ...

    Incorrect

    • Who was the originator of the term 'stigma'?

      Your Answer:

      Correct Answer: Erving Goffman

      Explanation:

      Erving Goffman was a prominent sociologist who made significant contributions to the field. He is well-known for his works such as The Presentation of Self in Everyday Life, Asylums, and Stigma. In fact, he is credited with introducing the term stigma into the sociological lexicon. Goffman’s ideas and theories have had a lasting impact on the study of sociology and continue to be studied and applied today.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 86 - What is a true statement about Argyll Robertson pupils? ...

    Incorrect

    • What is a true statement about Argyll Robertson pupils?

      Your Answer:

      Correct Answer: They are a feature of late-stage syphilis

      Explanation:

      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.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 87 - What condition is identified by the combination of Parkinsonism, cerebellar ataxia, and autonomic...

    Incorrect

    • What condition is identified by the combination of Parkinsonism, cerebellar ataxia, and autonomic failure?

      Your Answer:

      Correct Answer: Multisystem atrophy

      Explanation:

      Multisystem Atrophy: A Parkinson Plus Syndrome

      Multisystem atrophy is a type of Parkinson plus syndrome that is characterized by three main features: Parkinsonism, autonomic failure, and cerebellar ataxia. It can present in three different ways, including Shy-Drager Syndrome, Striatonigral degeneration, and Olivopontocerebellar atrophy, each with varying degrees of the three main features.

      Macroscopic features of multisystem atrophy include pallor of the substantia nigra, greenish discoloration and atrophy of the putamen, and cerebellar atrophy. Microscopic features include the presence of Papp-Lantos bodies, which are alpha-synuclein inclusions found in oligodendrocytes in the substantia nigra, cerebellum, and basal ganglia.

      Overall, multisystem atrophy is a complex and debilitating condition that affects multiple systems in the body, leading to a range of symptoms and challenges for patients and their caregivers.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 88 - What is the mechanism of action of memantine? ...

    Incorrect

    • What is the mechanism of action of memantine?

      Your Answer:

      Correct Answer: NMDA antagonist

      Explanation:

      Mechanisms of Action of Different Drugs

      Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 89 - The campaign Changing Minds was initiated by the Royal College of Psychiatry to...

    Incorrect

    • The campaign Changing Minds was initiated by the Royal College of Psychiatry to address the issue of stigmatizing individuals with mental health conditions. What was the launch date of this campaign?

      Your Answer:

      Correct Answer: 1998

      Explanation:

      The Changing Minds Campaign had a five-year run from 1998 to 2003. Its primary objective was to raise awareness and understanding of six prevalent mental health issues, namely anxiety, depression, schizophrenia, dementia, alcohol and drug addiction, and eating disorders. These conditions affect a significant portion of the population, with anxiety affecting over 10% of individuals, depression affecting 25%, schizophrenia affecting 1%, dementia affecting 20% of those over 80, alcohol and drug addiction affecting about one-third of people, and eating disorders affecting 1 in 50 individuals.

    • This question is part of the following fields:

      • Stigma And Culture
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  • Question 90 - If a certain nerve is damaged, which reflex may not occur during the...

    Incorrect

    • If a certain nerve is damaged, which reflex may not occur during the jaw jerk test?

      Your Answer:

      Correct Answer: Trigeminal

      Explanation:

      Cranial Nerve Reflexes

      When it comes to questions on cranial nerve reflexes, it is important to match the reflex to the nerves involved. Here are some examples:

      – Pupillary light reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
      – Accommodation reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
      – Jaw jerk: involves the trigeminal nerve (sensory and motor).
      – Corneal reflex: involves the trigeminal nerve (sensory) and facial nerve (motor).
      – Vestibulo-ocular reflex: involves the vestibulocochlear nerve (sensory) and oculomotor, trochlear, and abducent nerves (motor).

      Another example of a cranial nerve reflex is the gag reflex, which involves the glossopharyngeal nerve (sensory) and the vagus nerve (motor). This reflex is important for protecting the airway from foreign objects of substances that may trigger a gag reflex. It is also used as a diagnostic tool to assess the function of these nerves.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 91 - A concerned parent of a 25-year-old daughter with schizophrenia wants to know what...

    Incorrect

    • A concerned parent of a 25-year-old daughter with schizophrenia wants to know what the biggest challenge is for individuals living with this condition and how it affects their overall quality of life.

      Your Answer:

      Correct Answer: People with schizophrenia live with the stigma of the illness and are often seen as dangerous by society

      Explanation:

      Norman Sartorius highlights the iatrogenic stigma of mental illness as the main obstacle to a better life for those suffering from mental disorders. NICE guidelines on schizophrenia also acknowledge the stigma associated with the condition, which is often seen as dangerous and best dealt with away from society. However, research has shown that the fear of violence arising from people with schizophrenia is misplaced. Other factors that may contribute to feelings of exclusion and isolation include compulsory treatment under mental health legislation, medication side effects, and less careful use of diagnostic labels.

    • This question is part of the following fields:

      • Stigma And Culture
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  • Question 92 - In which sensory modality does formication occur? ...

    Incorrect

    • In which sensory modality does formication occur?

      Your Answer:

      Correct Answer: Tactile

      Explanation:

      The feeling of insects crawling on the skin, also known as tactile hallucination, is referred to as formication. This symptom has been extensively studied and can be caused by various factors.

      Altered Perceptual Experiences

      Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.

      Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.

      Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 93 - The defining characteristic of virtue theory is: ...

    Incorrect

    • The defining characteristic of virtue theory is:

      Your Answer:

      Correct Answer: The character of the person

      Explanation:

      Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.

      More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 94 - What signs of symptoms would indicate a possible diagnosis of Turner syndrome? ...

    Incorrect

    • What signs of symptoms would indicate a possible diagnosis of Turner syndrome?

      Your Answer:

      Correct Answer: Webbed neck

      Explanation:

      Understanding Turner Syndrome

      Turner syndrome is a genetic disorder that affects only females. It occurs when one of the two X chromosomes is missing of partially missing. This happens randomly and does not increase the risk of the condition in future siblings. Although X-inactivation occurs in females, having only one X chromosome can cause issues as not all genes are inactivated in the inactivated X chromosome.

      The features of Turner syndrome include short stature, a webbed neck, a broad chest with widely spaced nipples, gonadal dysfunction leading to amenorrhea and infertility, congenital heart disease, and hypothyroidism. Despite these physical characteristics, girls with Turner syndrome typically have normal intelligence, with a mean full-scale IQ of 90. However, they may struggle with nonverbal, social, and psychomotor skills. It is important to understand the symptoms and effects of Turner syndrome to provide appropriate care and support for affected individuals.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 95 - What is a true statement about XYY syndrome? ...

    Incorrect

    • What is a true statement about XYY syndrome?

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Genetics
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  • Question 96 - Which gene, present in an extra copy in individuals with Down's syndrome, is...

    Incorrect

    • Which gene, present in an extra copy in individuals with Down's syndrome, is associated with an elevated risk of developing Alzheimer's disease?

      Your Answer:

      Correct Answer: Amyloid precursor protein

      Explanation:

      The increased likelihood of Alzheimer’s disease in individuals with Down’s syndrome is believed to be linked to their inheritance of an additional copy of the amyloid precursor protein (APP) found on chromosome 21.

      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.

    • This question is part of the following fields:

      • Genetics
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  • Question 97 - How many levels did Maslow's original model of needs include? ...

    Incorrect

    • How many levels did Maslow's original model of needs include?

      Your Answer:

      Correct Answer: 5

      Explanation:

      Maslow’s Hierarchy of Needs is a theory of motivation introduced by Abraham Maslow. The hierarchy consists of five levels, with the most basic needs at the bottom and the most advanced needs at the top. Maslow proposed that a person would only become concerned with the needs of a particular level when all the needs of the lower levels had been satisfied. The levels include physiological needs, safety needs, social needs, esteem needs, and self-actualization needs. Maslow also made a distinction between D-needs (deficiency needs) and B-needs (being needs), with B-needs allowing us to reach our full potential but only after D-needs have been satisfied. Later in life, Maslow expanded upon the model and included cognitive, aesthetic, and transcendence needs, resulting in an eight-staged model. The cognitive needs include knowledge and understanding, while aesthetic needs involve appreciation and search for beauty. Transcendence needs are motivated by values that transcend beyond the personal self.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 98 - What is the prevalence rate of a medical condition in a particular region?...

    Incorrect

    • What is the prevalence rate of a medical condition in a particular region?

      Your Answer:

      Correct Answer: The rate of occurrence of new cases over a period of time in a defined population

      Explanation:

      Disease frequency can be measured using incidence, which counts the number of new cases of a disease in a specific population during a specified time period. Period prevalence refers to the number of existing cases during a given time period, while point prevalence refers to the number of existing cases at a specific point in time. The total disease burden within a population, of crude rate, is determined by the total number of people with the disease in that population. It is important to note that the number of newly diagnosed cases alone cannot determine the incidence rate, as it lacks a denominator.

    • This question is part of the following fields:

      • Epidemiology
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  • Question 99 - Which of the options below is not classified as a type of motor...

    Incorrect

    • Which of the options below is not classified as a type of motor neuron disease?

      Your Answer:

      Correct Answer: Multisystem atrophy

      Explanation:

      Motor neuron Disease: A Progressive Neurodegenerative Condition

      Motor neuron Disease (MND) is a condition that progressively damages the upper and lower motor neurons. This damage leads to muscle weakness and wasting, resulting in a loss of mobility in the limbs, as well as difficulties with speech, swallowing, and breathing. MND can be classified into four main types, including Amyotrophic lateral sclerosis, Progressive bulbar palsy, Progressive muscular atrophy, and Primary lateral sclerosis.

      Macroscopic pathological features of MND include atrophy of the precentral gyrus and frontotemporal regions, thinning of the spinal cord, and atrophic anterior nerve roots. Microscopic changes involve the loss of motor neurons from the ventral horn of the spinal cord and lower brainstem. MND is a devastating condition that currently has no cure, and treatment is focused on managing symptoms and improving quality of life for those affected.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 100 - A client visiting your practice informs you that they have been informed that...

    Incorrect

    • A client visiting your practice informs you that they have been informed that grapefruit juice may have an impact on their SSRI antidepressant. What is the most suitable guidance you can provide?

      Your Answer:

      Correct Answer: Grapefruit juice and also some other citrus juices should be avoided

      Explanation:

      The cytochrome P450 enzyme system, responsible for metabolizing SSRIs and certain cholesterol-lowering medications, can be inhibited by consuming grapefruit juice and other juices like lime juice. Therefore, patients taking SSRI antidepressants should avoid these juices.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 101 - What is the method used to identify the mode of inheritance for a...

    Incorrect

    • What is the method used to identify the mode of inheritance for a particular trait?

      Your Answer:

      Correct Answer: Segregation analysis

      Explanation:

      Segregation and Linkage Analysis in Genetics

      In genetics, segregation analysis is a statistical approach that helps determine the mode of inheritance of a specific phenotype using family data. On the other hand, linkage analysis is a method used to identify the genetic location of a disease gene. The primary objective of linkage analysis is to find a piece of DNA that is inherited by all affected family members and not by any unaffected members. Once this DNA segment is identified, it indicates that the disease gene is located nearby. Both segregation and linkage analysis are crucial tools in genetic research, helping scientists understand the inheritance patterns of genetic traits and diseases. By using these methods, researchers can identify the genetic basis of various disorders and develop effective treatments.

    • This question is part of the following fields:

      • Genetics
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  • Question 102 - In which sleep stage are K complexes mostly observed? ...

    Incorrect

    • In which sleep stage are K complexes mostly observed?

      Your Answer:

      Correct Answer: II

      Explanation:

      Sleep Stages

      Sleep is divided into two distinct states called rapid eye movement (REM) and non-rapid eye movement (NREM). NREM is subdivided into four stages.

      Sleep stage
      Approx % of time spent in stage
      EEG findings
      Comment

      I
      5%
      Theta waves (4-7 Hz)
      The dozing off stage. Characterized by hypnic jerks: spontaneous myoclonic contractions associated with a sensation of twitching of falling.

      II
      45%
      Theta waves, K complexes and sleep spindles (short bursts of 12-14 Hz activity)
      Body enters a more subdued state including a drop in temperature, relaxed muscles, and slowed breathing and heart rate. At the same time, brain waves show a new pattern and eye movement stops.

      III
      15%
      Delta waves (0-4 Hz)
      Deepest stage of sleep (high waking threshold). The length of stage 3 decreases over the course of the night.

      IV
      15%
      Mixed, predominantly beta
      High dream activity.

      The percentage of REM sleep decreases with age.

      It takes the average person 15-20 minutes to fall asleep, this is called sleep latency (characterised by the onset of stage I sleep). Once asleep one descends through stages I-II and then III-IV (deep stages). After about 90 minutes of sleep one enters REM. The rest of the sleep comprises of cycles through the stages. As the sleep progresses the periods of REM become greater and the periods of NREM become less. During an average night’s sleep one spends 25% of the sleep in REM and 75% in NREM.

      REM sleep has certain characteristics that separate it from NREM

      Characteristics of REM sleep

      – Autonomic instability (variability in heart rate, respiratory rate, and BP)
      – Loss of muscle tone
      – Dreaming
      – Rapid eye movements
      – Penile erection

      Deafness:

      (No information provided on deafness in relation to sleep stages)

    • This question is part of the following fields:

      • Neurosciences
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  • Question 103 - What is the sole authorized therapy for tardive dyskinesia in the United Kingdom?...

    Incorrect

    • What is the sole authorized therapy for tardive dyskinesia in the United Kingdom?

      Your Answer:

      Correct Answer: Tetrabenazine

      Explanation:

      Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 104 - What SPECT finding is indicative of Alzheimer's disease? ...

    Incorrect

    • What SPECT finding is indicative of Alzheimer's disease?

      Your Answer:

      Correct Answer: Decreased temporal perfusion

      Explanation:

      Given the medial temporal lobe atrophy commonly observed in Alzheimer’s disease, a reduction in perfusion of the temporal lobe would be anticipated.

      Alzheimer’s disease can be differentiated from healthy older individuals by using SPECT imaging to detect temporal and parietal hypoperfusion, according to studies such as one conducted by W. Jagust in 2001. Additionally, SPECT imaging has proven to be a useful tool in distinguishing between Alzheimer’s disease and Lewy body dementia, as demonstrated in a study by Vaamonde-Gamo in 2005. The image provided shows a SPECT scan of a patient with Alzheimer’s disease compared to one with Lewy body dementia, with the latter showing lower perfusion in the occipital cortex and the former showing lower perfusion in medial temporal areas.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 105 - A 25-year-old male patient when asked by the psychiatrist to sit down in...

    Incorrect

    • A 25-year-old male patient when asked by the psychiatrist to sit down in the consultation room takes three steps back from the chair. He eventually sits down when the psychiatrist insists.
      Which of the following symptoms of schizophrenia is he displaying?

      Your Answer:

      Correct Answer: Negativism

      Explanation:

      Motor and Behavioural Disturbances in Schizophrenia

      Schizophrenia is often characterized by a range of motor and behavioural disturbances, which can be difficult to distinguish from one another. These disturbances can manifest in various ways, and may be arbitrary in nature.

      One common behavioural motor disorder seen in schizophrenia is negativism, which involves actively resisting attempts to make contact with the patient. This can make it challenging to communicate with and treat individuals with this condition.

      Another disturbance is in advertence, where the patient may turn towards the examiner in a bizarre, exaggerated, and inflexible manner when addressed. This can make it difficult to establish a rapport with the patient and understand their needs.

      Ambitendency is another common disturbance, where the patient alternates between cooperation and opposition, leading to unpredictable and diffident behaviour. This can make it challenging to establish a consistent treatment plan and maintain progress.

      Finally, satyriasis is a specific type of motor and behavioural disturbance seen in males with schizophrenia, characterized by excessive sexual activity. This can be a challenging symptom to manage and may require specialized treatment approaches.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 106 - What is a true statement about flashbulb memory? ...

    Incorrect

    • What is a true statement about flashbulb memory?

      Your Answer:

      Correct Answer: It occurs at times of increased emotional arousal

      Explanation:

      Flashbulb Memory

      Flashbulb memories are vivid and detailed recollections of the circumstances surrounding a significant event. These memories are typically episodic, meaning they are focused on the specific details of the event rather than just the facts. One example of a flashbulb memory might be recalling where you were and what you were doing when you first heard about the death of Princess Diana in 1997. What sets flashbulb memories apart from other types of memories is the high level of emotional arousal that accompanies them. This emotional intensity helps to cement the memory in the mind, making it more vivid and long-lasting.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 107 - What is the most common subtype of Creutzfeldt-Jakob disease (CJD) that is responsible...

    Incorrect

    • What is the most common subtype of Creutzfeldt-Jakob disease (CJD) that is responsible for the majority of cases?

      Your Answer:

      Correct Answer: sCJDMM1 and sCJDMV1

      Explanation:

      CJD has several subtypes, including familial (fCJD), iatrogenic (iCJD), sporadic (sCJD), and new variant (vCJD). The most common subtype is sCJD, which makes up 85% of cases. sCJD can be further classified based on the MV polymorphisms at codon 129 of the PRNP gene, with sCJDMM1 and sCJDMV1 being the most prevalent subtypes. fCJD is the most common subtype after sCJD, while vCJD and iCJD are rare and caused by consuming contaminated food of tissue contamination from other humans, respectively.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 108 - What is the origin of agoraphobia? ...

    Incorrect

    • What is the origin of agoraphobia?

      Your Answer:

      Correct Answer: Escape conditioning is involved

      Explanation:

      Beck identified two cognitive distortions, catastrophization and selective abstraction, which play a role in the development of depression. These distortions involve magnifying negative events and selectively focusing on negative aspects, respectively.

    • This question is part of the following fields:

      • Aetiology
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  • Question 109 - Which of the options below does not belong to the category of small...

    Incorrect

    • Which of the options below does not belong to the category of small molecule neurotransmitters?

      Your Answer:

      Correct Answer: Prolactin

      Explanation:

      Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 110 - Which of the following is another term for a neuropathic gait? ...

    Incorrect

    • Which of the following is another term for a neuropathic gait?

      Your Answer:

      Correct Answer: Equine gait

      Explanation:

      Gait disorders can be caused by a variety of conditions, including neurological, muscular, and structural abnormalities. One common gait disorder is hemiplegic gait, which is characterized by unilateral weakness on the affected side, with the arm flexed, adducted, and internally rotated, and the leg on the same side in extension with plantar flexion of the foot and toes. When walking, the patient may hold their arm to one side and drag their affected leg in a semicircle (circumduction) due to weakness of leg flexors and extended foot. Hemiplegic gait is often seen in patients who have suffered a stroke.

      Other gait disorders include ataxic gait, spastic gait, and steppage gait, each with their own unique characteristics and associated conditions. Accurate diagnosis and treatment of gait disorders is important for improving mobility and quality of life for affected individuals.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 111 - Can excessive alcohol consumption lead to a decrease in white blood cell count?...

    Incorrect

    • Can excessive alcohol consumption lead to a decrease in white blood cell count?

      Your Answer:

      Correct Answer: WBC

      Explanation:

      Alcohol Dependence Blood Profile

      Alcohol dependence can have a significant impact on an individual’s blood profile. Several markers tend to be elevated in individuals with alcohol dependence, including GGT, AST, MCV, and ALT. Among these markers, GGT is considered the most reliable indicator of recent alcohol use. This means that elevated levels of GGT in the blood can suggest that an individual has consumed alcohol recently.

      It is important to note that these blood markers may not be elevated in all individuals with alcohol dependence, and other factors can also contribute to changes in blood profile. However, monitoring these markers can be useful in assessing an individual’s alcohol use and identifying potential health risks associated with alcohol dependence. Healthcare professionals can use this information to develop appropriate treatment plans and support individuals in managing their alcohol use.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 112 - A chromosome that has a very short p arm, making it difficult to...

    Incorrect

    • A chromosome that has a very short p arm, making it difficult to observe, is known as:

      Your Answer:

      Correct Answer: Telocentric

      Explanation:

      Understanding Centromeres

      A centromere is a crucial part of DNA that connects two sister chromatids. It plays a vital role in cell division by keeping the sister chromatids aligned and allowing the chromosomes to be lined up during metaphase. The position of the centromere divides the chromosome into two arms, the long (q) and the short (p). Chromosomes are classified based on the position of the centromere. Metacentric chromosomes have arms of roughly equal length, and they can be formed by Robertsonian translocations. Acrocentric chromosomes can also be involved in Robertsonian translocations. Monocentric chromosomes have only one centromere and form a narrow constriction, while holocentric chromosomes have the entire length of the chromosome acting as the centromere. Understanding the role and classification of centromeres is essential in comprehending the process of cell division.

    • This question is part of the following fields:

      • Genetics
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  • Question 113 - What is the main way in which galantamine works? ...

    Incorrect

    • What is the main way in which galantamine works?

      Your Answer:

      Correct Answer: Competitive and reversible inhibitor of acetylcholinesterase

      Explanation:

      Pharmacological management of dementia involves the use of acetylcholinesterase inhibitors (AChE inhibitors) and memantine. AChE inhibitors prevent the breakdown of acetylcholine, which is deficient in Alzheimer’s due to the loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are commonly used AChE inhibitors in the management of Alzheimer’s. However, gastrointestinal side effects such as nausea and vomiting are common with these drugs.

      Memantine, on the other hand, is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction. It has a half-life of 60-100 hours and is primarily renally eliminated. Common adverse effects of memantine include somnolence, dizziness, hypertension, dyspnea, constipation, headache, and elevated liver function tests.

      Overall, pharmacological management of dementia aims to improve cognitive function and slow down the progression of the disease. However, it is important to note that these drugs do not cure dementia and may only provide temporary relief of symptoms.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 114 - What was the first SSRI to be introduced to the European market? ...

    Incorrect

    • What was the first SSRI to be introduced to the European market?

      Your Answer:

      Correct Answer: Zimeldine

      Explanation:

      Although fluoxetine was the first SSRI to be approved and marketed in the United States, it took over seven years of clinical trials (Phase I-Phase III) to do so. Meanwhile, Astra AB introduced zimeldine (Zelmid®), the first SSRI, to the European market in March 1982. However, zimeldine, which was derived from pheniramine, was taken off the European market in September 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome, an acute peripheral neuropathy. The hypersensitivity reactions were similar to a flu-like syndrome and included fever, joint/muscle pain, headaches, and hepatic effects.

      A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor

      In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.

      Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 115 - Among the SSRIs, which one is most likely to result in notable weight...

    Incorrect

    • Among the SSRIs, which one is most likely to result in notable weight gain?

      Your Answer:

      Correct Answer: Paroxetine

      Explanation:

      Antidepressants and Weight Gain

      Studies suggest that certain types of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), may be more likely to cause weight gain than newer antidepressants like selective serotonin reuptake inhibitors (SSRIs). However, mirtazapine, a newer antidepressant, may have a similar risk for weight gain as TCAs. Among SSRIs, paroxetine may have a higher risk for weight gain during long-term treatment compared to other SSRIs. On the other hand, bupropion and nefazodone may have a lower risk for weight gain than SSRIs in the long term.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 116 - Which attachment theorist differentiated between deprivation and privation? ...

    Incorrect

    • Which attachment theorist differentiated between deprivation and privation?

      Your Answer:

      Correct Answer: Spitz

      Explanation:

      René Spitz’s Study on Anaclitic Depression in Children

      René Spitz conducted a study on children who were deprived of their primary caregiver and found that they experienced a type of depression known as anaclitic depression. This type of depression is characterized by a lack of interest in the environment, a decrease in physical activity, and a failure to thrive. Spitz’s study highlights the importance of a primary caregiver in a child’s development and the negative effects of deprivation on their emotional and physical well-being. The study emphasizes the need for children to form secure attachments with their caregivers to promote healthy development.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments