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  • Question 1 - A 3-year-old girl wakes up crying in the middle of the night. This...

    Correct

    • A 3-year-old girl wakes up crying in the middle of the night. This typically occurs shortly after she has fallen asleep. Her parents report that she sits up in bed and appears to be awake but does not acknowledge them. The episodes last for a few minutes before the child falls back asleep. The parents have checked her pulse during these episodes and note that it is very rapid. This started happening around six months ago and lasted for about two weeks before resolving on its own. What is the likely diagnosis?

      Your Answer: Night terrors

      Explanation:

      Night terrors are a type of sleep disorder that typically occur during the first few hours of sleep. They are characterized by sudden and intense feelings of fear, panic, of terror that can cause the person to scream, thrash around, of even try to escape from their bed. Unlike nightmares, which occur during REM sleep and are often remembered upon waking, night terrors occur during non-REM sleep and are usually not remembered. Night terrors are most common in children, but can also occur in adults. They are thought to be caused by a combination of genetic and environmental factors, and may be triggered by stress, anxiety, of sleep deprivation. Treatment for night terrors may include improving sleep hygiene, reducing stress, and in some cases, medication.

    • This question is part of the following fields:

      • Neurosciences
      42.2
      Seconds
  • Question 2 - What is the closest estimate of heritability in schizophrenia? ...

    Incorrect

    • What is the closest estimate of heritability in schizophrenia?

      Your Answer: 80%

      Correct Answer: 55%

      Explanation:

      Heritability: Understanding the Concept

      Heritability is a concept that is often misunderstood. It is not a measure of the extent to which genes cause a condition in an individual. Rather, it is the proportion of phenotypic variance attributable to genetic variance. In other words, it tells us how much of the variation in a condition seen in a population is due to genetic factors. Heritability is calculated using statistical techniques and can range from 0.0 to 1.0. For human behavior, most estimates of heritability fall in the moderate range of .30 to .60.

      The quantity (1.0 – heritability) gives the environment ability of the trait. This is the proportion of phenotypic variance attributable to environmental variance. The following table provides estimates of heritability for major conditions:

      Condition Heritability estimate (approx)
      ADHD 85%
      Autism 70%
      Schizophrenia 55%
      Bipolar 55%
      Anorexia 35%
      Alcohol dependence 35%
      Major depression 30%
      OCD 25%

      It is important to note that heritability tells us nothing about individuals. It is a population-level measure that helps us understand the relative contributions of genetic and environmental factors to a particular condition.

    • This question is part of the following fields:

      • Genetics
      53.8
      Seconds
  • Question 3 - What is a characteristic feature of Argyll Robertson pupils? ...

    Incorrect

    • What is a characteristic feature of Argyll Robertson pupils?

      Your Answer: They show a sluggish response to both light and accommodation

      Correct Answer: Dilation is typically poor with mydriatic agents

      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
      18.8
      Seconds
  • Question 4 - What factor has been demonstrated to have a notable impact on the QTc...

    Incorrect

    • What factor has been demonstrated to have a notable impact on the QTc interval?

      Your Answer: Prune juice

      Correct Answer: Grapefruit juice

      Explanation:

      Amantadine and QTc Prolongation

      Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

    • This question is part of the following fields:

      • Psychopharmacology
      10.9
      Seconds
  • Question 5 - A middle-aged individual reports regularly wearing their partner's clothing without feeling sexually aroused,...

    Correct

    • A middle-aged individual reports regularly wearing their partner's clothing without feeling sexually aroused, maintaining a positive relationship with their partner, and having no desire to permanently identify as the opposite gender. What diagnosis would be most appropriate for this individual's situation?

      Your Answer: Dual-role transvestism

      Explanation:

      Types of Gender and Sexual Identity

      Dual-role transvestism refers to the act of wearing clothing typically associated with the opposite sex without experiencing discomfort with one’s biological gender of a desire to permanently live as the opposite sex. This behavior is not accompanied by sexual arousal, which distinguishes it from fetishistic transvestism. Fetishistic transvestism, on the other hand, involves wearing clothing of the opposite sex for the purpose of sexual arousal. Transsexualism is a desire to live as a member of the opposite sex, often accompanied by discomfort with one’s biological gender and a desire for gender reassignment. Sexual dysfunction encompasses a range of difficulties with sexual desire and performance.

    • This question is part of the following fields:

      • Diagnosis
      31.7
      Seconds
  • Question 6 - What is the most probable cause of negative consequences when consuming alcohol? ...

    Incorrect

    • What is the most probable cause of negative consequences when consuming alcohol?

      Your Answer: Possessing very inactive forms of alcohol catalase

      Correct Answer: Possessing very active forms of alcohol dehydrogenase

      Explanation:

      The accumulation of acetaldehyde in the bloodstream is responsible for the negative consequences of alcohol consumption, which can occur when alcohol dehydrogenase is active of aldehyde dehydrogenase is inactive.

      Genetics and Alcoholism

      Alcoholism tends to run in families, and several studies confirm that biological children of alcoholics are more likely to develop alcoholism even when adopted by parents without the condition. Monozygotic twins have a greater concordance rate for alcoholism than dizygotic twins. Heritability estimates range from 45 to 65 percent for both men and women. While genetic differences affect risk, there is no “gene for alcoholism,” and both environmental and social factors weigh heavily on the outcome.

      The genes with the clearest contribution to the risk for alcoholism and alcohol consumption are alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). The first step in ethanol metabolism is oxidation to acetaldehyde, by ADHs. The second step is metabolism of the acetaldehyde to acetate by ALDHs. Individuals carrying even a single copy of the ALDH2*504K display the “Asian flushing reaction” when they consume even small amounts of alcohol. There is one significant genetic polymorphism of the ALDH2 gene, resulting in allelic variants ALDH2*1 and ALDH2*2, which is virtually inactive. ALDH2*2 is present in about 50 percent of the Taiwanese, Han Chinese, and Japanese populations. It is extremely rare outside Asia. Nearly no individuals of European of African descent carry this allele. ALDH2*504K has repeatedly been demonstrated to have a protective effect against alcohol use disorders.

      The three different class I gene loci, ADH1A (alpha), ADH1B (beta), and ADH1C (gamma) are situated close to each other in the region 4q2123. The alleles ADH1C*1 and ADH1B*2 code for fast metabolism of alcohol. The ADH1B*1 slow allele is very common among Caucasians, with approximately 95 percent having the homozygous ADH1B*1/1 genotype and 5 percent having the heterozygous ADH1B*1/2 genotype. The ADH1B*2 allele is the most common allele in Asian populations. In African populations, the ADH1B*1 allele is the most common.

    • This question is part of the following fields:

      • Genetics
      21.1
      Seconds
  • Question 7 - What is a true statement about Erikson's theory of human development? ...

    Correct

    • What is a true statement about Erikson's theory of human development?

      Your Answer: It accords with the 'epigenetic principle'

      Explanation:

      Erik Erikson and Daniel Levinson expanded the understanding of adult development. Erikson proposed a life-span model of human development consisting of eight successive psychosocial stages, each associated with an inherent conflict of crisis that the individual must encounter and successfully resolve to proceed with development. Levinson proposed a developmental theory consisting of universal stages of phases that extend from the infancy state to the elderly state, based on biographical interviews of 40 men in America. Both theorists maintained that personality develops in a predetermined order and builds upon each previous stage, and that failure to successfully negotiate a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self. However, Levinson’s theory is age-based rather than event-based, and his model proposed a ‘life sequence’ consisting of a series of alternating stable (structure-building) periods and cross-era transitional (structure-changing) periods, with transitional periods typically lasting 5 years.

    • This question is part of the following fields:

      • Psychological Development
      10.8
      Seconds
  • Question 8 - One statement that is false regarding the genetics of ADHD is: ADHD is...

    Incorrect

    • One statement that is false regarding the genetics of ADHD is: ADHD is caused by a single gene mutation.

      Your Answer: Concordance rates for monozygotic twins are higher than those of dizygotic twins

      Correct Answer: ADHD has been associated with the neuregulin 1 gene

      Explanation:

      While ADHD has been linked to various genes, neuregulin 1 is not among them. However, it has been suggested to play a role in schizophrenia.

      ADHD and Genetics

      Decades of research have shown that genetics play a crucial role in the development of attention deficit hyperactivity disorder (ADHD) and its comorbidity with other disorders. However, twin estimates of heritability being less than 100% suggest that environmental factors also play a role. Parents and siblings of a child with ADHD are more likely to have ADHD themselves, but the way ADHD is inherited is complex and not related to a single genetic fault. The heritability of ADHD is around 74%, and longitudinal studies show that two-thirds of ADHD youth will continue to have impairing symptoms of ADHD in adulthood. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors. The heritability is similar in males and females, and studies suggest that the diagnosis of ADHD is the extreme of a continuous distribution of ADHD symptoms in the population. Several candidate genes, including DAT1, DRD4, DRD5, 5 HTT, HTR1B, and SNAP25, have been identified as significantly associated with ADHD.

      Source: Faraone (2019) Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry volume 24, pages 562–575 (2019).

    • This question is part of the following fields:

      • Genetics
      23
      Seconds
  • Question 9 - Self-injurious behaviour is linked to a lack of which enzyme? ...

    Correct

    • Self-injurious behaviour is linked to a lack of which enzyme?

      Your Answer: Hypoxanthine phosphoribosyltransferase

      Explanation:

      Niemann-Pick disease is caused by a deficiency in sphingomyelinase.

      Lesch-Nyhan Syndrome: A Rare Genetic Disorder

      Lesch-Nyhan syndrome is a rare genetic disorder that causes the overproduction and accumulation of uric acid in the body, leading to various health problems such as gouty arthritis, kidney stones, and subcutaneous tophi. The condition primarily affects males and is caused by mutations in the HPRT gene located on the X-chromosome.

      People with Lesch-Nyhan syndrome typically experience motor disability, including severe dystonia, hypotonia, and choreoathetosis, which can make it difficult of impossible for them to walk of sit without assistance. They may also exhibit self-injurious behavior, such as biting and head-banging, which is the most common and distinctive behavioral problem associated with the condition. Intellectual disability is common, but severe cognitive impairment is rare.

      The absence of the HPRT enzyme, which is responsible for recycling purine bases, leads to the accumulation of uric acid and affects the development of specific neural pathways in the brain, particularly the mesotelencephalic dopamine pathways. This disruption is likely responsible for the motor disability and behavioral peculiarities associated with the condition.

      Treatment for self-injurious behavior typically involves the use of protective restraints applied to the limbs, trunk, of head to prevent self-hitting of self-biting. Dental extraction may be necessary in cases of lip of tongue biting. Behavior modification methods that involve extinction may also be used, but neuroleptics may be required during particularly stressful of difficult behavior periods. However, these medications should only be used transiently due to their sedative effects and potential side-effects.

    • This question is part of the following fields:

      • Psychological Development
      13.9
      Seconds
  • Question 10 - A 35 year old anxious man, during the course of his therapy, says...

    Incorrect

    • A 35 year old anxious man, during the course of his therapy, says that he is calm but the whole world is anxious. Which of the following defense mechanisms does this illustrate?:

      Your Answer: Projective identification

      Correct Answer: Projection

      Explanation:

      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
      9.5
      Seconds
  • Question 11 - Which of the following is the least likely to cause discontinuation symptoms? ...

    Incorrect

    • Which of the following is the least likely to cause discontinuation symptoms?

      Your Answer: Venlafaxine

      Correct Answer: Fluoxetine

      Explanation:

      Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).

    • This question is part of the following fields:

      • Psychopharmacology
      14.5
      Seconds
  • Question 12 - What medication would be most strongly recommended for a patient with schizophrenia and...

    Incorrect

    • What medication would be most strongly recommended for a patient with schizophrenia and olanzapine induced weight gain who did not respond well to aripiprazole and continues to experience distressing auditory hallucinations?

      Your Answer: Risperidone

      Correct Answer: Lurasidone

      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
      28.1
      Seconds
  • Question 13 - In the basal ganglia, what structures make up the lenticular nucleus, including the...

    Correct

    • In the basal ganglia, what structures make up the lenticular nucleus, including the globus pallidus and which other component?

      Your Answer: Putamen

      Explanation:

      Located in the epithalamus at the center of the brain, the pineal gland is an endocrine gland. The basal ganglia, also known as basal nuclei, consist of four primary components: the caudate, nucleus accumbens, putamen, globus pallidus, subthalamic nucleus, and substantia nigra. The lenticular (of lentiform) nucleus is formed by the globus pallidus and putamen.

    • This question is part of the following fields:

      • Neurosciences
      109.1
      Seconds
  • Question 14 - In which region of the monkey's cortex were mirror neurons initially identified? ...

    Incorrect

    • In which region of the monkey's cortex were mirror neurons initially identified?

      Your Answer: Primary somatosensory cortex

      Correct Answer: Premotor cortex

      Explanation:

      Visuomotor neurons known as mirror neurons are situated in the premotor cortex. These neurons were initially identified in a specific region of the premotor cortex in monkeys called area F5, but have since been observed in the inferior parietal lobule as well (Rizzolatti 2001).

      Mirror Neurons: A Model for Imitation Learning

      Mirror neurons are a unique type of visuomotor neurons that were first identified in the premotor cortex of monkeys in area F5. These neurons fire not only when the monkey performs a specific action but also when it observes another individual, whether it is a monkey of a human, performing a similar action. This discovery has led to the development of a model for understanding imitation learning.

      Mirror neurons offer a fascinating insight into how humans and animals learn by imitation. They provide a neural mechanism that allows individuals to understand the actions of others and to replicate those actions themselves. This process is essential for social learning, as it enables individuals to learn from others and to adapt to their environment.

      The discovery of mirror neurons has also led to new research in the field of neuroscience, as scientists seek to understand how these neurons work and how they can be used to improve our understanding of human behavior. As we continue to learn more about mirror neurons, we may be able to develop new therapies for individuals with social and communication disorders, such as autism.

      Overall, mirror neurons are a fascinating area of research that has the potential to revolutionize our understanding of human behavior and learning. By studying these neurons, we may be able to unlock new insights into how we learn, communicate, and interact with others.

    • This question is part of the following fields:

      • Neurosciences
      17.7
      Seconds
  • Question 15 - Which drug class is most likely to result in QTc interval prolongation? ...

    Incorrect

    • Which drug class is most likely to result in QTc interval prolongation?

      Your Answer: Antiepileptics

      Correct Answer: Antimalarials

      Explanation:

      Amantadine and QTc Prolongation

      Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

    • This question is part of the following fields:

      • Psychopharmacology
      10.1
      Seconds
  • Question 16 - What is the contribution of Crow to the understanding of schizophrenia? ...

    Incorrect

    • What is the contribution of Crow to the understanding of schizophrenia?

      Your Answer: He was the first to treat schizophrenia with ECT

      Correct Answer: He divided patients with schizophrenia into type I and type II

      Explanation:

      Historical Classification of Schizophrenia

      The classification of schizophrenia has evolved over time, with various individuals contributing to its development. In 1801, Phillippe Pinel used the term ‘demencé’ to describe the loss of mental abilities in chronically ill patients. Benedict Morel coined the term ‘demencé precocé’ in 1852 to describe young patients with premature dementia. Kahlbaum was the first to describe ‘paraphrenia hebetica’ in the 1860s, which was later elaborated as ‘hebephrenia’ by Hecker in 1871.

      In 1893, Emil Kraepelin used the term dementia praecox to describe the condition, emphasizing the importance of delusions, hallucinations, impaired attention, thought incoherence, stereotyped movements and expressions, deterioration of emotional life, and a loss of drive as key symptoms. In 1908, Eugen Bleuler coined the term ‘schizophrenia’ to replace dementia praecox, denoting ‘a splitting of the psychic functions.’ Bleuler expanded the concept to include presentations that did not include a ‘terminal state.’

      Bleuler introduced a distinction between basic and accessory symptoms and primary and secondary symptoms. Basic symptoms are necessarily present in any case of schizophrenia, while accessory symptoms may of may not occur. The fundamental features of schizophrenia were loosening of associations, disturbances of affectivity, ambivalence, and autism. The alteration of associations is the only symptom that Bleuler regarded as both basic and primary, and can thus be described as the core disturbance in the Bleulerian conception of schizophrenia.

      In 1939, Langfeldt introduced the term ‘schizophreniform psychosis’ to describe patients with Bleulerian schizophrenia who did not follow a progressively deteriorating course. In the 1960s, Rado/Meehl introduced the term ‘schizotypy’ to recognize the concept of a continuum of spectrum of schizophrenia-related phenotypes. In the 1980s, Crow proposed a subclassification of schizophrenia, dividing patients into types I and II. Type I patients present with positive symptoms such as delusions and hallucinations, while type II patients present with negative symptoms such as affective flattening and poverty of speech.

    • This question is part of the following fields:

      • Classification And Assessment
      11.2
      Seconds
  • Question 17 - What waveform represents a frequency range of 8-12Hz? ...

    Incorrect

    • What waveform represents a frequency range of 8-12Hz?

      Your Answer:

      Correct Answer: Alpha

      Explanation:

      Electroencephalography

      Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.

      Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.

      Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.

      Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.

      Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.

      Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.

    • This question is part of the following fields:

      • Neurosciences
      0
      Seconds
  • Question 18 - For which medical conditions is Modafinil prescribed? ...

    Incorrect

    • For which medical conditions is Modafinil prescribed?

      Your Answer:

      Correct Answer: Narcolepsy

      Explanation:

      Modafinil: A Psychostimulant for Wakefulness and Attention Enhancement

      Modafinil is a type of psychostimulant that is known to improve wakefulness, attention, and vigilance. Although it is similar to amphetamines, it does not produce the same euphoric effects and is not associated with dependence of tolerance. Additionally, it does not seem to cause psychosis. Modafinil is approved for the treatment of narcolepsy, obstructive sleep apnea, and chronic shift work. It is also suggested as an adjunctive treatment for depression by the Maudsley. Recently, it has gained popularity as a smart drug due to its potential to enhance cognitive functioning in healthy individuals.

    • This question is part of the following fields:

      • Psychopharmacology
      0
      Seconds
  • Question 19 - What is the truth about the discontinuation symptoms that are linked to antidepressants?...

    Incorrect

    • What is the truth about the discontinuation symptoms that are linked to antidepressants?

      Your Answer:

      Correct Answer: Suicidal thoughts are associated with discontinuation of paroxetine

      Explanation:

      Discontinuation symptoms are common when stopping most antidepressants, typically appearing within 5 days of treatment cessation. However, these symptoms are more likely to occur with short half-life drugs like paroxetine, especially when doses are missed. It’s important to note that discontinuing paroxetine may lead to suicidal thoughts, so patients should be informed of the potential risks associated with poor compliance.

      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
      0
      Seconds
  • Question 20 - What is the candidate gene for schizophrenia that is also associated with Velocardiofacial...

    Incorrect

    • What is the candidate gene for schizophrenia that is also associated with Velocardiofacial disorder?

      Your Answer:

      Correct Answer: COMT

      Explanation:

      Schizophrenia is a complex disorder that is associated with multiple candidate genes. No single gene has been identified as the sole cause of schizophrenia, and it is believed that the more genes involved, the greater the risk. Some of the important candidate genes for schizophrenia include DTNBP1, COMT, NRG1, G72, RGS4, DAOA, DISC1, and DRD2. Among these, neuregulin, dysbindin, and DISC1 are the most replicated and plausible genes, with COMT being the strongest candidate gene due to its role in dopamine metabolism. Low activity of the COMT gene has been associated with obsessive-compulsive disorder and schizophrenia. Neuregulin 1 is a growth factor that stimulates neuron development and differentiation, and increased neuregulin signaling in schizophrenia may suppress the NMDA receptor, leading to lowered glutamate levels. Dysbindin is involved in the biogenesis of lysosome-related organelles, and its expression is decreased in schizophrenia. DISC1 encodes a multifunctional protein that influences neuronal development and adult brain function, and it is disrupted in schizophrenia. It is located at the breakpoint of a balanced translocation identified in a large Scottish family with schizophrenia, schizoaffective disorder, and other major mental illnesses.

    • This question is part of the following fields:

      • Genetics
      0
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  • Question 21 - Which statement about drug distribution in the elderly is incorrect? ...

    Incorrect

    • Which statement about drug distribution in the elderly is incorrect?

      Your Answer:

      Correct Answer: Water soluble drugs show increased volumes of distribution in the elderly

      Explanation:

      Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.

      In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.

    • This question is part of the following fields:

      • Psychopharmacology
      0
      Seconds
  • Question 22 - An important function of hepatic metabolism is to make a drug: ...

    Incorrect

    • An important function of hepatic metabolism is to make a drug:

      Your Answer:

      Correct Answer: More water soluble

      Explanation:

      Understanding Biotransformation: A Metabolic Process for Excretion

      Biotransformation is a metabolic process that occurs primarily in the liver, but also in other organs such as the kidneys, intestine, adipose, skin, and lungs. Its main function is to facilitate the excretion of both exogenous and endogenous substances by altering their chemical structures through a series of reactions. Enzymes found in the cytoplasm, endoplasmic reticulum, and mitochondria of cells catalyze these reactions, which can cause the substrate to become inactive, active, of even toxic.

      Biotransformation is divided into three phases. Phase I reactions involve oxidation, reduction, of hydrolysis of the drug, yielding a polar, water-soluble metabolite that is often still active. Phase II reactions consist of adding hydrophilic groups to the original molecule, a toxic intermediate, of a nontoxic metabolite formed in phase I, to increase its polarity. The most common method is conjugation with glucuronic acid, but other groups such as sulphate, amino acids, acetate, and methyl can also be added. Phase III reactions occur post-phase II, where a chemical substance can undergo further metabolism and excretion through active transport into the urinary of hepatobiliary system.

      Understanding biotransformation is crucial in pharmacology and toxicology, as it affects the efficacy and toxicity of drugs and other substances. By facilitating the excretion of these substances, biotransformation helps maintain homeostasis in the body and prevent accumulation of potentially harmful compounds.

    • This question is part of the following fields:

      • Psychopharmacology
      0
      Seconds
  • Question 23 - What is the pathway for cerebrospinal fluid to return from the subarachnoid space...

    Incorrect

    • What is the pathway for cerebrospinal fluid to return from the subarachnoid space to the vascular system?

      Your Answer:

      Correct Answer: Subarachnoid villi

      Explanation:

      Cerebrospinal Fluid: Formation, Circulation, and Composition

      Cerebrospinal fluid (CSF) is produced by ependymal cells in the choroid plexus of the lateral, third, and fourth ventricles. It is constantly reabsorbed, so only a small amount is present at any given time. CSF occupies the space between the arachnoid and pia mater and passes through various foramina and aqueducts to reach the subarachnoid space and spinal cord. It is then reabsorbed by the arachnoid villi and enters the dural venous sinuses.

      The normal intracerebral pressure (ICP) is 5 to 15 mmHg, and the rate of formation of CSF is constant. The composition of CSF is similar to that of brain extracellular fluid (ECF) but different from plasma. CSF has a higher pCO2, lower pH, lower protein content, lower glucose concentration, higher chloride and magnesium concentration, and very low cholesterol content. The concentration of calcium and potassium is lower, while the concentration of sodium is unchanged.

      CSF fulfills the role of returning interstitial fluid and protein to the circulation since there are no lymphatic channels in the brain. The blood-brain barrier separates CSF from blood, and only lipid-soluble substances can easily cross this barrier, maintaining the compositional differences.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 24 - What type of memory is semantic memory responsible for? ...

    Incorrect

    • What type of memory is semantic memory responsible for?

      Your Answer:

      Correct Answer: Language and knowledge

      Explanation:

      Memory Forms

      Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.

      Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).

      Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.

      Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).

      Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 25 - What would be the most suitable method to evaluate the extent of a...

    Incorrect

    • What would be the most suitable method to evaluate the extent of a 32-year-old man's depression?

      Your Answer:

      Correct Answer: HAMD

      Explanation:

      The Geriatric Mental State Schedule (GMSS) is a tool utilized to detect signs of depression among older adults.

      In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 26 - Which of the following factors does not increase the risk of developing SIADH?...

    Incorrect

    • Which of the following factors does not increase the risk of developing SIADH?

      Your Answer:

      Correct Answer: Male gender

      Explanation:

      Hyponatremia in Psychiatric Patients

      Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 27 - In what setting is the Clifton Assessment Procedure used as an assessment tool?...

    Incorrect

    • In what setting is the Clifton Assessment Procedure used as an assessment tool?

      Your Answer:

      Correct Answer: Nursing homes for the elderly

      Explanation:

      Clifton Assessment Procedure (CAPE) is a valuable tool for evaluating the quality of life, cognitive impairments, and physical dependency levels in elderly individuals. It is used to identify areas of unmet needs and can be administered in both hospital and community settings. The assessment takes approximately 15-25 minutes to complete and comprises two scales: the cognitive assessment scale and the behavior rating scale. The cognitive assessment scale evaluates orientation, basic cognition, and psychomotor performance, while the behavior rating scale assesses physical dependency and behavioral problems. The CAPE can differentiate between organic brain disease and functional psychiatric disorders and predict the likelihood of hospital discharge. It is commonly used to determine the most appropriate placement for elderly individuals.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 28 - Which of the following is not a risk factor associated with low socioeconomic...

    Incorrect

    • Which of the following is not a risk factor associated with low socioeconomic class?

      Your Answer:

      Correct Answer: Anorexia nervosa

      Explanation:

      Social Class and Mental Disorder

      There is a consistent finding that shows an inverse relationship between social class and rates of mental illness. This means that individuals from lower social classes are more likely to experience mental health issues compared to those from higher social classes. However, this inverse relationship is not observed in the case of anorexia nervosa. This suggests that factors other than social class may play a more significant role in the development of this particular disorder. Overall, the relationship between social class and mental health is complex and requires further investigation to fully understand the underlying factors.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 29 - 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 30 - Which statement about serotonin is incorrect? ...

    Incorrect

    • Which statement about serotonin is incorrect?

      Your Answer:

      Correct Answer: It can cross the blood brain barrier

      Explanation:

      Serotonin: Synthesis and Breakdown

      Serotonin, also known as 5-Hydroxytryptamine (5-HT), is synthesized in the central nervous system (CNS) in the raphe nuclei located in the brainstem, as well as in the gastrointestinal (GI) tract in enterochromaffin cells. The amino acid L-tryptophan, obtained from the diet, is used to synthesize serotonin. L-tryptophan can cross the blood-brain barrier, but serotonin cannot.

      The transformation of L-tryptophan into serotonin involves two steps. First, hydroxylation to 5-hydroxytryptophan is catalyzed by tryptophan hydroxylase. Second, decarboxylation of 5-hydroxytryptophan to serotonin (5-hydroxytryptamine) is catalyzed by L-aromatic amino acid decarboxylase.

      Serotonin is taken up from the synapse by a monoamine transporter (SERT). Substances that block this transporter include MDMA, amphetamine, cocaine, TCAs, and SSRIs. Serotonin is broken down by monoamine oxidase (MAO) and then by aldehyde dehydrogenase to 5-Hydroxyindoleacetic acid (5-HIAA).

    • This question is part of the following fields:

      • Neurosciences
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  • Question 31 - Which receptors are affected by fluoxetine that are believed to be responsible for...

    Incorrect

    • Which receptors are affected by fluoxetine that are believed to be responsible for causing insomnia?

      Your Answer:

      Correct Answer: 5-HT2

      Explanation:

      Serotonin (5-hydroxytryptamine, 5-HT) receptors are primarily G protein receptors, except for 5-HT3, which is a ligand-gated receptor. It is important to remember that 5-HT3 is most commonly associated with nausea. Additionally, 5-HT7 is linked to circadian rhythms. The stimulation of 5-HT2 receptors is believed to be responsible for the side effects of insomnia, agitation, and sexual dysfunction that are associated with the use of selective serotonin reuptake inhibitors (SSRIs).

    • This question is part of the following fields:

      • Neurosciences
      0
      Seconds
  • Question 32 - At what age does puberty need to begin for it to be considered...

    Incorrect

    • At what age does puberty need to begin for it to be considered precocious in girls?

      Your Answer:

      Correct Answer: 8

      Explanation:

      Puberty

      Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 33 - Under which category of memory is priming classified? ...

    Incorrect

    • Under which category of memory is priming classified?

      Your Answer:

      Correct Answer: Nondeclarative memory

      Explanation:

      Memory Forms

      Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.

      Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).

      Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.

      Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).

      Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.

    • This question is part of the following fields:

      • Social Psychology
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      Seconds
  • Question 34 - In a patient with chronic schizophrenia on a stable dose of 2mg risperidone...

    Incorrect

    • In a patient with chronic schizophrenia on a stable dose of 2mg risperidone for 2 years, who develops worsening symptoms and is given an increased dose of 4 mg risperidone, what is the most likely cause of his current presentation of stiffness, fever, breathlessness, and sweating?

      Your Answer:

      Correct Answer: Neuroleptic malignant syndrome

      Explanation:

      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 35 - What is a true statement about the neocortex? ...

    Incorrect

    • What is a true statement about the neocortex?

      Your Answer:

      Correct Answer: It contains both pyramidal and nonpyramidal cells

      Explanation:

      The Cerebral Cortex and Neocortex

      The cerebral cortex is the outermost layer of the cerebral hemispheres and is composed of three parts: the archicortex, paleocortex, and neocortex. The neocortex accounts for 90% of the cortex and is involved in higher functions such as thought and language. It is divided into 6-7 layers, with two main cell types: pyramidal cells and nonpyramidal cells. The surface of the neocortex is divided into separate areas, each given a number by Brodmann (e.g. Brodmann’s area 17 is the primary visual cortex). The surface is folded to increase surface area, with grooves called sulci and ridges called gyri. The neocortex is responsible for higher cognitive functions and is essential for human consciousness.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 36 - What is the term used to describe a segment of DNA that does...

    Incorrect

    • What is the term used to describe a segment of DNA that does not code for proteins and is not translated?

      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 37 - How can the doctor-patient relationship be structured to prioritize a collaborative decision-making process?...

    Incorrect

    • How can the doctor-patient relationship be structured to prioritize a collaborative decision-making process?

      Your Answer:

      Correct Answer: Interpretive

      Explanation:

      Models of Doctor-Patient Relationship

      There are four distinct models of doctor-patient relationship that have been identified. The first is the paternalistic of autocratic model, which assumes that the doctor knows best and makes all decisions regarding treatment. The patient is expected to simply comply with the doctor’s orders. The second model is the informative model, where the doctor provides information to the patient and leaves the decision-making process entirely up to them. The third model is the interpretive model, where the doctor takes the time to understand the patient’s circumstances and helps them make a decision based on their unique situation. This model involves shared decision-making and active participation from the patient. Finally, the deliberative model involves the doctor acting as a friend to the patient and attempting to steer them in a particular course of action that they believe is in the patient’s best interest. However, ultimately, the choice is left up to the patient. Understanding these different models can help doctors and patients work together more effectively to achieve the best possible outcomes.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 38 - How can the principle of Premack be described? ...

    Incorrect

    • How can the principle of Premack be described?

      Your Answer:

      Correct Answer: High frequency behaviours can be used to reinforce low frequency behaviour

      Explanation:

      Premack’s Principle

      Premack’s principle is a concept that suggests that preferred behaviors can be utilized to reinforce unpreferred behaviors. This principle is based on the observation that high-probability behaviors, which are frequently performed under conditions of free choice, can be used to reinforce low-probability behaviors. For instance, parents can tell their children that they can have pudding only after they finish their main course. Similarly, children can be allowed to go out and play only after they have completed their homework. By using this principle, individuals can increase the likelihood of performing less preferred behaviors by linking them to more preferred behaviors.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 39 - Which statement accurately describes modafinil? ...

    Incorrect

    • Which statement accurately describes modafinil?

      Your Answer:

      Correct Answer: It lacks the euphoric effects of amphetamines

      Explanation:

      Modafinil: A Psychostimulant for Wakefulness and Attention Enhancement

      Modafinil is a type of psychostimulant that is known to improve wakefulness, attention, and vigilance. Although it is similar to amphetamines, it does not produce the same euphoric effects and is not associated with dependence of tolerance. Additionally, it does not seem to cause psychosis. Modafinil is approved for the treatment of narcolepsy, obstructive sleep apnea, and chronic shift work. It is also suggested as an adjunctive treatment for depression by the Maudsley. Recently, it has gained popularity as a smart drug due to its potential to enhance cognitive functioning in healthy individuals.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 40 - What is the tool used to evaluate the intelligence of children? ...

    Incorrect

    • What is the tool used to evaluate the intelligence of children?

      Your Answer:

      Correct Answer: WISC

      Explanation:

      The WISC, a commonly utilized IQ assessment for children, consists of ten distinct evaluations that generate performance and verbal IQ scores, as well as an overall IQ score. NART, on the other hand, is a measure of premorbid IQ, while Rivermead assesses visual memory. WAIS is the adult version of the Wechsler intelligence scale, and the Wisconsin card sorting test evaluates executive function, specifically the frontal lobe.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 41 - Who is credited with creating the term 'bipolar'? ...

    Incorrect

    • Who is credited with creating the term 'bipolar'?

      Your Answer:

      Correct Answer: Kleist

      Explanation:

      History of Psychiatric Terms

      In the exams, it is important to be familiar with the individuals associated with certain psychiatric terms. For example, Kraepelin is associated with dementia praecox and manic depression, while Bleuler is associated with schizophrenia. Other terms and their associated individuals include Hebephrenia (Hecker), Catatonia (Kahlbaum), Schizoaffective (Kasanin), Neurasthenia (Beard), Unipolar and bipolar (Kleist), Hypnosis (Braid), Group dynamics (Lewin), Group psychotherapy (Moreno), Psychopathic inferiority (Koch), Psychiatry (Reil), and Institutional Neurosis (Barton).

      It should be noted that there is some debate over the origins of certain terms. While Kraepelin is often credited with coining the term dementia praecox, some sources suggest that it was first used in its Latin form by Arnold Pick in 1891. The original term demence precoce was first used by Morel in 1852. Despite this, the College appears to favor the Kraepelin attribution.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 42 - 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 43 - What is the commonly used scale in research studies to assess symptoms of...

    Incorrect

    • What is the commonly used scale in research studies to assess symptoms of schizophrenia?

      Your Answer:

      Correct Answer: PANSS

      Explanation:

      The PANSS scale is a commonly utilized tool in schizophrenia research to assess both positive and negative symptoms. The BDI measures depression using the Beck inventory, while the Calgary scale is specifically designed to rate depression in individuals with schizophrenia. CIWA is a scale used to evaluate the severity of alcohol withdrawal, and LUNSER is a rating scale for neuroleptic side effects developed by Liverpool University.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 44 - What type of MRI scan is available? ...

    Incorrect

    • What type of MRI scan is available?

      Your Answer:

      Correct Answer: DTI

      Explanation:

      Neuroimaging techniques can be divided into structural and functional types, although this distinction is becoming less clear as new techniques emerge. Structural techniques include computed tomography (CT) and magnetic resonance imaging (MRI), which use x-rays and magnetic fields, respectively, to produce images of the brain’s structure. Functional techniques, on the other hand, measure brain activity by detecting changes in blood flow of oxygen consumption. These include functional MRI (fMRI), emission tomography (PET and SPECT), perfusion MRI (pMRI), and magnetic resonance spectroscopy (MRS). Some techniques, such as diffusion tensor imaging (DTI), combine both structural and functional information to provide a more complete picture of the brain’s anatomy and function. DTI, for example, uses MRI to estimate the paths that water takes as it diffuses through white matter, allowing researchers to visualize white matter tracts.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 45 - Prior to initiating lithium treatment for an adult with a learning disability and...

    Incorrect

    • Prior to initiating lithium treatment for an adult with a learning disability and comorbid affective disorder, which baseline investigation should be conducted?

      Your Answer:

      Correct Answer: ECG

      Explanation:

      There is controversy surrounding the question, likely due to its poor wording. However, some sources suggest that the correct answer is EEG. This may be based on a one-time recommendation in the Frith Prescribing Guidelines from 2005, which suggests that an EEG is necessary before starting lithium due to its potential to lower the seizure threshold, which is particularly relevant for individuals with LD who are prone to seizures. However, this recommendation has not been supported by NICE, the BNF, of the Maudsley Guidelines, so it should be viewed with caution. NICE and the Maudsley do recommend that all individuals have an ECG before starting lithium, so choosing that answer would be a safe choice.

      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 46 - What is the estimated degree of genetic influence on autism? ...

    Incorrect

    • What is the estimated degree of genetic influence on autism?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      Heritability: Understanding the Concept

      Heritability is a concept that is often misunderstood. It is not a measure of the extent to which genes cause a condition in an individual. Rather, it is the proportion of phenotypic variance attributable to genetic variance. In other words, it tells us how much of the variation in a condition seen in a population is due to genetic factors. Heritability is calculated using statistical techniques and can range from 0.0 to 1.0. For human behavior, most estimates of heritability fall in the moderate range of .30 to .60.

      The quantity (1.0 – heritability) gives the environment ability of the trait. This is the proportion of phenotypic variance attributable to environmental variance. The following table provides estimates of heritability for major conditions:

      Condition Heritability estimate (approx)
      ADHD 85%
      Autism 70%
      Schizophrenia 55%
      Bipolar 55%
      Anorexia 35%
      Alcohol dependence 35%
      Major depression 30%
      OCD 25%

      It is important to note that heritability tells us nothing about individuals. It is a population-level measure that helps us understand the relative contributions of genetic and environmental factors to a particular condition.

    • This question is part of the following fields:

      • Genetics
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  • Question 47 - A woman is arrested by the police for strangling her husband. She believes...

    Incorrect

    • A woman is arrested by the police for strangling her husband. She believes he has been replaced by an impostor. Select the appropriate delusional syndrome:

      Your Answer:

      Correct Answer: Capgras

      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 48 - What is the most frequently observed side effect of clozapine? ...

    Incorrect

    • What is the most frequently observed side effect of clozapine?

      Your Answer:

      Correct Answer: Hypersalivation

      Explanation:

      Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 49 - What is the highest ranking life event on the social readjustment rating scale...

    Incorrect

    • What is the highest ranking life event on the social readjustment rating scale according to Holmes and Rahe's research?

      Your Answer:

      Correct Answer: Death of spouse

      Explanation:

      Holmes and Rahe (1967) developed the social readjustment rating scale, which consisted of 43 life events of different levels of severity that appeared to occur before the onset of patients’ illnesses. The researchers analyzed 5000 patient records and found that the death of a spouse was the most serious life event, while a minor violation of the law was the least serious. Although this measure aimed to measure the impact of life events, it has received numerous criticisms, such as its failure to consider individual circumstances and its incomplete list of life events.

    • This question is part of the following fields:

      • Basic Psychological Processes
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  • Question 50 - What is a known complication associated with the use of valproate? ...

    Incorrect

    • What is a known complication associated with the use of valproate?

      Your Answer:

      Correct Answer: Pancreatitis

      Explanation:

      The use of valproate can lead to pancreatitis, which is a known and potentially fatal complication.

      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
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  • Question 51 - Which brain system enables the integration of emotional sensory information between the cortex...

    Incorrect

    • Which brain system enables the integration of emotional sensory information between the cortex and hypothalamus?

      Your Answer:

      Correct Answer: Papez circuit

      Explanation:

      In 1937, James Papez proposed a neural circuit that explained how emotional experiences occur in the brain. According to Papez, sensory messages related to emotional stimuli are first received by the thalamus, which then directs them to both the cortex (stream of thinking) and hypothalamus (stream of feeling). The cingulate cortex integrates this information from the hypothalamus and sensory cortex, leading to emotional experiences. The output via the hippocampus and hypothalamus allows cortical control of emotional responses. This circuit has since been reconceptualized as the limbic system.

      The medial longitudinal fasciculus carries fibres from cranial nerves III, IV and IV. The nucleus accumbens plays a major role in the reward circuit, while the somatosensory cortex is involved in processing pain. The basal ganglia are involved in voluntary motor control.

      Overall, the Papez circuit theory provides a framework for understanding the functional neuroanatomy of emotion. It highlights the importance of the limbic system in emotional experiences and the role of various brain regions in processing different aspects of emotional stimuli.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 52 - At what Tanner stage does menarche typically occur? ...

    Incorrect

    • At what Tanner stage does menarche typically occur?

      Your Answer:

      Correct Answer: 4

      Explanation:

      Puberty

      Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 53 - What is the meaning of the term autochthonous delusion? ...

    Incorrect

    • What is the meaning of the term autochthonous delusion?

      Your Answer:

      Correct Answer: A primary delusion

      Explanation:

      Borderline Learning Disability

      Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 54 - What is located within Brodmann area 22? ...

    Incorrect

    • What is located within Brodmann area 22?

      Your Answer:

      Correct Answer: Wernicke's area

      Explanation:

      Broca’s and Wernicke’s are two types of expressive dysphasia, which is characterized by difficulty producing speech despite intact comprehension. Dysarthria is a type of expressive dysphasia caused by damage to the speech production apparatus, while Broca’s aphasia is caused by damage to the area of the brain responsible for speech production, specifically Broca’s area located in Brodmann areas 44 and 45. On the other hand, Wernicke’s aphasia is a type of receptive of fluent aphasia caused by damage to the comprehension of speech, while the actual production of speech remains normal. Wernicke’s area is located in the posterior part of the superior temporal gyrus in the dominant hemisphere, within Brodmann area 22.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 55 - What is the opioid system modulator that is prescribed to decrease alcohol consumption?...

    Incorrect

    • What is the opioid system modulator that is prescribed to decrease alcohol consumption?

      Your Answer:

      Correct Answer: Nalmefene

      Explanation:

      Nalmefene is a medication that affects the opioid system by partially activating the κ receptor and blocking the μ and σ receptors. It is believed to reduce the pleasurable effects of alcohol by targeting the mesolimbic system and opioid receptors, helping individuals decrease their alcohol consumption.

      Acamprosate works by targeting NMDA and GABA receptors, which can reduce the urge to drink alcohol.

      Disulfiram inhibits the enzyme acetaldehyde dehydrogenase, which is involved in breaking down alcohol. If someone drinks alcohol while taking disulfiram, they may experience a severe and potentially deadly reaction due to the buildup of acetaldehyde. Disulfiram is typically used by individuals who have stopped drinking and want to maintain their sobriety.

      Naltrexone is a medication that blocks opioid receptors and can be used to treat both opioid and alcohol addiction.

      Naloxone is a short-acting medication that blocks opioid receptors and is used in emergency situations to treat opioid overdose.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 56 - What is the heuristic that best explains a junior psychiatrist's misdiagnosis of a...

    Incorrect

    • What is the heuristic that best explains a junior psychiatrist's misdiagnosis of a simple case of depression as a rare mental health condition they recently read about?

      Your Answer:

      Correct Answer: Availability

      Explanation:

      Heuristics: Cognitive Shortcuts that can Lead to Diagnostic Errors

      In the 1970s, Tversky and Kahneman proposed that humans use cognitive heuristics, of mental shortcuts, to simplify complex decision-making processes. However, these heuristics can also lead to systematic errors. One such heuristic is the representativeness bias, where individuals judge the likelihood of an event based on how closely it resembles a stereotype. For example, a person described as shy and detail-oriented may be more likely to be perceived as a librarian than a farmer.

      Another heuristic is the availability bias, where individuals favor recent and readily available information over more accurate but less accessible information. This can lead to overestimating the frequency of certain events, such as violent crime. The anchoring-and-adjustment bias occurs when individuals lock onto salient features in a patient’s initial presentation and fail to adjust their impression in light of new information.

      The framing effect is another bias where individuals react differently to a choice depending on how the information is presented. For example, a pharmaceutical company may present a drug as having a 95% cure rate, making it seem superior to a drug with a 2.5% failure rate. Base rate neglect occurs when individuals ignore underlying incident rates of population-based knowledge, leading to unnecessary testing of treatment.

      Confirmation bias is a tendency to interpret information to fit preconceived diagnoses, rather than considering alternative explanations. The conjunction rule is the incorrect belief that the probability of multiple events being true is greater than a single event. Finally, diagnostic momentum occurs when clinicians continue a course of action initiated by previous clinicians without considering new information.

      Overall, while heuristics can be useful in simplifying complex decision-making processes, they can also lead to diagnostic errors if not used appropriately. It is important for clinicians to be aware of these biases and actively work to avoid them in their practice.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 57 - What physiological factor is the QTc, calculated using Bazett's formula, corrected for? ...

    Incorrect

    • What physiological factor is the QTc, calculated using Bazett's formula, corrected for?

      Your Answer:

      Correct Answer: RR interval

      Explanation:

      The Bazett formula adjusts the QT interval for heart rate by taking the square root of the R-R interval and dividing the QT interval by it.

      QTc Prolongation: Risks and Identification

      The QT interval is a measure of the time it takes for the ventricles to repolarize and is calculated from the beginning of the QRS complex to the end of the T wave. However, the QT interval varies with the heart rate, making it difficult to use a single number as a cut-off for a prolonged QT. Instead, a corrected QT interval (QTc) is calculated for each heart rate using various formulas. A QTc over the 99th percentile is considered abnormally prolonged, with approximate values of 470 ms for males and 480 ms for females.

      Prolonged QT intervals can lead to torsade de pointes (TdP), a polymorphic ventricular tachycardia that can be fatal if it degenerates into ventricular fibrillation. TdP is characterized by a twisting of the QRS complexes around an isoelectric line and is often asymptomatic but can also be associated with syncope and death. An accurate diagnosis requires an ECG to be recorded during the event. It is important to note that an increase in the QT interval due to a new conduction block should not be considered indicative of acquired LQTS and risk for TdP.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 58 - Which of the following neuroanatomical structures is larger on the left in a...

    Incorrect

    • Which of the following neuroanatomical structures is larger on the left in a healthy right-handed female aged 25-30 years?

      Your Answer:

      Correct Answer: Transverse temporal gyrus

      Explanation:

      The Heschl gyrus, also known as the transverse temporal gyrus, is a component of the primary auditory complex located in the temporal lobe. It is noteworthy that the left Heschl gyrus is typically larger than the right. This structure is responsible for processing incoming auditory information and is unique in its mediolateral orientation. The brain hemispheres exhibit structural differences, with the left hemisphere (in over 90% of right-handed individuals) specializing in language function. Another structure within the primary auditory complex, the planum temporale, is also typically larger on the left side (up to ten times larger). Conversely, the amygdala, caudate nucleus, cingulate sulcus, and hippocampus are typically larger on the right side.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 59 - A 30-year-old woman is evaluating her character traits. She is responding to a...

    Incorrect

    • A 30-year-old woman is evaluating her character traits. She is responding to a series of statements using a scale ranging from 'strongly disagree' to 'strongly agree'.

      Which personality assessment tool is she utilizing?

      Your Answer:

      Correct Answer: Personality assessment inventory (PAI)

      Explanation:

      There are several different types of personality assessments available. The personality assessment inventory (PAI) is a self-report test with 344 items and 22 scales, using a Likert-type format. Likert items ask respondents to rate their level of agreement of disagreement with a statement. The 16 personality factor questionnaire (16 PF) is a self-report questionnaire with true/false format, measuring 16 different personality dimensions. The Minnesota multiphasic personality inventory (MMPI) is an objective measure of personality in adults, with 566 true/false items. The Beck depression inventory is a self-report inventory with 21 multiple choice questions, used to measure the severity of depression. Finally, the thematic apperception test (TAT) is a projective measure of personality, using 20 stimulus cards depicting scenes of varying ambiguity.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 60 - What is a known risk factor for QT prolongation when analyzing an ECG?...

    Incorrect

    • What is a known risk factor for QT prolongation when analyzing an ECG?

      Your Answer:

      Correct Answer: Hypokalemia

      Explanation:

      Amantadine and QTc Prolongation

      Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 61 - Which condition is marked by an increased appetite and being overweight? ...

    Incorrect

    • Which condition is marked by an increased appetite and being overweight?

      Your Answer:

      Correct Answer: Prader-Willi syndrome

      Explanation:

      Prader-Willi Syndrome: A Genetic Disorder with Unique Characteristics

      Prader-Willi Syndrome is a genetic disorder that occurs when there is a deletion of genetic material from the paternal chromosome 15. This condition is a classic example of imprinting, where the expression of certain genes is dependent on whether they are inherited from the mother of father. The syndrome is characterized by several unique features, including hyperphagia (excessive eating) and obesity, short stature, delayed puberty, hypogonadism, infertility, learning difficulties, and compulsive behavior such as skin picking.

    • This question is part of the following fields:

      • Genetics
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  • Question 62 - Which type of injury of damage typically leads to utilization behaviour? ...

    Incorrect

    • Which type of injury of damage typically leads to utilization behaviour?

      Your Answer:

      Correct Answer: Frontal lobe

      Explanation:

      Abnormal Motor Behaviours Associated with Utilization Behaviour

      Utilization behaviour (UB) is a condition where patients exhibit exaggerated and inappropriate motor responses to environmental cues and objects. This behaviour is automatic and instrumentally correct, but not contextually appropriate. For instance, a patient may start brushing their teeth when presented with a toothbrush, even in a setting where it is not expected. UB is caused by frontal lobe lesions that result in a loss of inhibitory control.

      Other motor abnormalities associated with UB include imitation behaviour, where patients tend to imitate the examiner’s behaviour, and the alien hand sign, where patients experience bizarre hand movements that they cannot control. Manual groping behaviour is also observed, where patients automatically manipulate objects placed in front of them. The grasp reflex, which is normal in infants, should not be present in children and adults. It is an automatic tendency to grip objects of stimuli, such as the examiner’s hand.

      Environmental Dependency Syndrome is another condition associated with UB. It describes deficits in personal control of action and an overreliance on social and physical environmental stimuli to guide behaviour in a social context. For example, a patient may start commenting on pictures in an examiner’s office, believing it to be an art gallery.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 63 - 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 64 - What is a frequently observed side effect of varenicline? ...

    Incorrect

    • What is a frequently observed side effect of varenicline?

      Your Answer:

      Correct Answer: Nasopharyngitis

      Explanation:

      Varenicline for Smoking Cessation: Safety and Efficacy

      Varenicline is a medication used to aid smoking cessation by reducing cravings and pleasurable effects of tobacco products. It has a high affinity for the alpha 4 beta 2 nicotinic receptor and is recommended by NICE for smoking cessation. Varenicline is safe to use in cases of liver dysfunction as it undergoes very little hepatic metabolism. It has been found to be nearly 80% more effective than bupropion and more effective than 24-hour nicotine replacement therapy in two large randomized controlled trials. The initial course of treatment could last 12 weeks, with an additional 12 weeks offered to those who have successfully quit smoking. However, varenicline has been observed to exacerbate underlying psychiatric illness, including depression, and is associated with changes in behavior of thinking, anxiety, psychosis, mood swings, aggressive behavior, suicidal ideation, and behavior. Patients with a psychiatric history should be closely monitored while taking varenicline. One randomized controlled trial has challenged this concern. The FDA has issued a safety announcement that varenicline may be associated with a small, increased risk of certain cardiovascular adverse events in patients with cardiovascular disease. The very common side effects of varenicline include nasopharyngitis, abnormal dreams, insomnia, headache, and nausea.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 65 - 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:

      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
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  • Question 66 - A client in their 60s reports experiencing a tremor that fluctuates significantly. Upon...

    Incorrect

    • A client in their 60s reports experiencing a tremor that fluctuates significantly. Upon observation, you observe that the tremor subsides when the client is distracted. What type of tremor do you suspect?

      Your Answer:

      Correct Answer: Psychogenic tremor

      Explanation:

      Types of Tremor

      Essential Tremor

      Otherwise known as benign essential tremor, this is the most common type of tremor. It is not associated with any underlying pathology. It usually begins in the 40’s, affects mainly the hands, and is slowly progressive. It tends to worsen with heightened emotion. It usually presents with unilateral upper limb involvement then progresses to both limbs.

      Parkinsonian Tremor

      This tremor is associated with Parkinson’s disease. It is classically described as ‘pill rolling’ due to the characteristic appearance of the fingers.

      Cerebellar Tremor

      Otherwise known as an intention tremor. This is a slow, coarse tremor which gets worse with purposeful movement. This is seen in lithium toxicity (note that the tremor seen as a side effect of long term lithium is fine and classed as physiological).

      Psychogenic Tremor

      Also known as a hysterical tremor. This type of tremor tends to appear and disappear suddenly and is hard to characterise due to its changeable nature. It tends to improve with distraction.

      Physiologic Tremor

      This is a very-low-amplitude fine tremor that is barely visible to the naked eye. It is present in every normal person while maintaining a posture of movement. It becomes enhanced and visible in many conditions such as anxiety, hyperthyroidism, alcohol withdrawal, and as drug induced side effects.

      It is useful to have a basic idea about the frequencies of different types of tremor.

      Type of Tremor Frequency

      Intention 2-3Hz

      Parkinsonian 5Hz

      Essential 7Hz

      Physiological 10Hz

      Psychogenic variable

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 67 - Which of the following accurately defines a pseudohallucination? Please rephrase the question slightly...

    Incorrect

    • Which of the following accurately defines a pseudohallucination? Please rephrase the question slightly and maintain the paragraph spacing.

      Your Answer:

      Correct Answer: A hallucination without the quality of a normal percept

      Explanation:

      Pseudohallucinations are often distinguished from true hallucinations by their lack of a genuine perceptual quality, although this distinction can be challenging to apply in practice. True hallucinations can be induced by illicit drug use. extracampine hallucinations, which are typically visual and occur outside of the normal sensory field, are considered true hallucinations. Pseudohallucinations are not exclusive to schizophrenia and can manifest in various sensory modalities.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 68 - All of the following contribute to the sleep enhancing properties of mirtazapine except:...

    Incorrect

    • All of the following contribute to the sleep enhancing properties of mirtazapine except:

      Your Answer:

      Correct Answer: Alpha 2 antagonist

      Explanation:

      Mirtazapine is known to enhance sleep through its effects on various receptors, including 5HT2, 5HT3, and H1, as well as alpha 1 antagonist. However, its alpha 2 antagonist may actually inhibit the release of norepinephrine and potentially diminish the sleep-enhancing effects of the drug at higher dosages. Therefore, doses of 30mg of less are typically used to treat insomnia. (Source: Foundations of Psychiatric Sleep Medicine, Cambridge University Press, 2011, p.224)

      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 69 - What substance belongs to the category of catecholamines? ...

    Incorrect

    • What substance belongs to the category of catecholamines?

      Your Answer:

      Correct Answer: Dopamine

      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 70 - What is another name for the forebrain in the developing embryo? ...

    Incorrect

    • What is another name for the forebrain in the developing embryo?

      Your Answer:

      Correct Answer: Prosencephalon

      Explanation:

      Neurodevelopment: Understanding Brain Development

      The development of the central nervous system begins with the neuroectoderm, a specialized region of ectoderm. The embryonic brain is divided into three areas: the forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The prosencephalon further divides into the telencephalon and diencephalon, while the hindbrain subdivides into the metencephalon and myelencephalon.

      The telencephalon, of cerebrum, consists of the cerebral cortex, underlying white matter, and the basal ganglia. The diencephalon includes the prethalamus, thalamus, hypothalamus, subthalamus, epithalamus, and pretectum. The mesencephalon comprises the tectum, tegmentum, ventricular mesocoelia, cerebral peduncles, and several nuclei and fasciculi.

      The rhombencephalon includes the medulla, pons, and cerebellum, which can be subdivided into a variable number of transversal swellings called rhombomeres. In humans, eight rhombomeres can be distinguished, from caudal to rostral: Rh7-Rh1 and the isthmus. Rhombomeres Rh7-Rh4 form the myelencephalon, while Rh3-Rh1 form the metencephalon.

      Understanding neurodevelopment is crucial in comprehending brain development and its complexities. By studying the different areas of the embryonic brain, we can gain insight into the formation of the central nervous system and its functions.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 71 - Which waves are present at the onset of stage 2 sleep, in addition...

    Incorrect

    • Which waves are present at the onset of stage 2 sleep, in addition to k-complexes?

      Your Answer:

      Correct Answer: Sigma

      Explanation:

      Electroencephalography

      Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.

      Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.

      Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.

      Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.

      Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.

      Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 72 - 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 73 - Which syndrome is also referred to as Trisomy 18? ...

    Incorrect

    • Which syndrome is also referred to as Trisomy 18?

      Your Answer:

      Correct Answer: Edward's syndrome

      Explanation:

      Aneuploidy: Abnormal Chromosome Numbers

      Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.

      Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.

      The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.

    • This question is part of the following fields:

      • Genetics
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  • Question 74 - Among the listed antipsychotics, which one has the greatest likelihood of causing extrapyramidal...

    Incorrect

    • Among the listed antipsychotics, which one has the greatest likelihood of causing extrapyramidal side effects?

      Your Answer:

      Correct Answer: Haloperidol

      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 75 - Can you identify the brain structure that is not found in both cerebral...

    Incorrect

    • Can you identify the brain structure that is not found in both cerebral hemispheres?

      Your Answer:

      Correct Answer: Pineal gland

      Explanation:

      Neuroanatomical Structures

      The pineal gland is a unique structure in the brain that is not present bilaterally. It is a small endocrine gland responsible for producing melatonin, a hormone derived from serotonin. Along with the pituitary gland and circumventricular organs, the pineal gland is one of the few unpaired structures in the brain.

      In contrast, the caudate nucleus is a paired structure located within the basal ganglia. It is present bilaterally and plays a crucial role in motor control and learning.

      The midbrain contains the Mammillary body, which is also a paired structure involved in long-term memory formation. These structures work together to help us remember and recall past experiences.

      Finally, the supraoptic nucleus is duplicated in each cerebral hemisphere. This structure is involved in regulating water balance and plays a critical role in maintaining homeostasis in the body.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 76 - Which process breaks down dopamine? ...

    Incorrect

    • Which process breaks down dopamine?

      Your Answer:

      Correct Answer: COMT and both forms of MAO

      Explanation:

      COMT and both types of MAO are responsible for the metabolism of dopamine.

      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 77 - Which statement accurately describes late onset Alzheimer's disease? ...

    Incorrect

    • Which statement accurately describes late onset Alzheimer's disease?

      Your Answer:

      Correct Answer: The APOE3 variant is considered the neutral variant

      Explanation:

      Genetics plays a role in the development of Alzheimer’s disease, with different genes being associated with early onset and late onset cases. Early onset Alzheimer’s, which is rare, is linked to three genes: amyloid precursor protein (APP), presenilin one (PSEN-1), and presenilin two (PSEN-2). The APP gene, located on chromosome 21, produces a protein that is a precursor to amyloid. The presenilins are enzymes that cleave APP to produce amyloid beta fragments, and alterations in the ratios of these fragments can lead to plaque formation. Late onset Alzheimer’s is associated with the apolipoprotein E (APOE) gene on chromosome 19, with the E4 variant increasing the risk of developing the disease. People with Down’s syndrome are also at high risk of developing Alzheimer’s due to inheriting an extra copy of the APP gene.

    • This question is part of the following fields:

      • Genetics
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  • Question 78 - At what stage of development, as described by Mahler, is separation anxiety typically...

    Incorrect

    • At what stage of development, as described by Mahler, is separation anxiety typically initially noticed?

      Your Answer:

      Correct Answer: Separation-individuation first subphase - Differentiation

      Explanation:

      Mahler’s Separation-Individuation theory of child development proposes that personality development occurs in distinct stages. The first stage, the Autistic phase, occurs during the first few weeks of life, where the child is mostly sleeping and cut off from the world. The second stage, the Symbiotic phase, lasts until around six months of age, where the child sees themselves and their mother as a single unit. The third stage, Separation-Individuation, has four subphases. The first subphase, Differentiation, occurs between six to ten months, where the child begins to see themselves as an individual and experiences separation anxiety. The second subphase, Practicing, occurs between ten to sixteen months, where the child explores connections with the external world and people other than the mother. The third subphase, Rapprochement, occurs between sixteen to twenty-four months, where the child struggles to balance their desire for independence and proximity to the mother, often resulting in tantrums and the use of transitional objects. The fourth subphase, Object constancy, occurs between twenty-four to thirty-six months, where the child accepts the idea of object constancy and is more comfortable with the mother being separate for periods of time.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 79 - Who is recognized as the originator of the mental age concept? ...

    Incorrect

    • Who is recognized as the originator of the mental age concept?

      Your Answer:

      Correct Answer: Binet

      Explanation:

      Mental Age and IQ

      The concept of mental age (MA) was introduced by Alfred Binet in 1905. It involves administering a series of tests to a person of child, which are then ranked according to the age at which people are expected to complete them. The mental age can be used to calculate the intelligence quotient (IQ) using the formula: IQ = MA/CA x 100, where CA is the chronological age. An IQ of 100 indicates that the mental and chronological ages are equal. IQ tends to remain stable throughout life. The Stanford-Binet test was the first IQ test, while the WAIS-IV (Wechsler Adult Intelligence Scale) is the most commonly used IQ test today.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 80 - Which of the following is not assessed in the MMSE? ...

    Incorrect

    • Which of the following is not assessed in the MMSE?

      Your Answer:

      Correct Answer: Executive function

      Explanation:

      Although individuals with executive cognitive dysfunction may receive a normal score on the MMSE, they can still experience significant impairments in their daily functioning.

      Mini Mental State Exam (MMSE)

      The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 81 - A 45-year-old woman who is on methadone treatment for opioid addiction needs to...

    Incorrect

    • A 45-year-old woman who is on methadone treatment for opioid addiction needs to take antipsychotic medication for a new episode of psychosis. She has had a positive response to haloperidol in the past. What is the most crucial test to monitor potential side effects of this medication combination?

      Your Answer:

      Correct Answer: ECG

      Explanation:

      When using methadone and haloperidol together, it is important to closely monitor the QTc interval due to their significant effect on it. EEG and electrolyte screening are not necessary. While liver function tests may be useful to perform periodically, they are not the primary concern with this combination. It is important to be cautious of respiratory depression when using high doses of methadone in combination with other sedative medications, but respiratory function tests are unlikely to provide helpful information.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 82 - What is a frequently observed side-effect of lisdexamfetamine? ...

    Incorrect

    • What is a frequently observed side-effect of lisdexamfetamine?

      Your Answer:

      Correct Answer: Decreased appetite

      Explanation:

      ADHD medications can be classified into stimulant and non-stimulant drugs. The therapeutic effects of these drugs are believed to be mediated through the action of noradrenaline in the prefrontal cortex. Common side effects of these drugs include decreased appetite, insomnia, nervousness, headache, and nausea. Stimulant drugs like dexamphetamine, methylphenidate, and lisdexamfetamine inhibit the reuptake of dopamine and noradrenaline. Non-stimulant drugs like atomoxetine, guanfacine, and clonidine work by increasing noradrenaline levels in the synaptic cleft through different mechanisms. The most common side effects of these drugs are decreased appetite, somnolence, headache, and abdominal pain.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 83 - Among the following groups, which has the highest occurrence of individuals with poor...

    Incorrect

    • Among the following groups, which has the highest occurrence of individuals with poor metabolism of CYP2D6?

      Your Answer:

      Correct Answer: Africans and African-Americans

      Explanation:

      The Cytochrome P450 system is a group of enzymes that metabolize drugs by altering their functional groups. The system is located in the liver and small intestine and is involved in drug interactions through enzyme induction of inhibition. Notable inducers include smoking, alcohol, and St John’s Wort, while notable inhibitors include grapefruit juice and some SSRIs. CYP2D6 is important due to genetic polymorphism, and CYP3A4 is the most abundant subfamily and is commonly involved in interactions. Grapefruit juice inhibits both CYP1A2 and CYP3A4, while tobacco smoking induces CYP1A2. The table summarizes the main substrates, inhibitors, and inducers for each CYP enzyme.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 84 - A 28-year-old man with a recent onset of seizures and a family history...

    Incorrect

    • A 28-year-old man with a recent onset of seizures and a family history of epilepsy is referred for an EEG. He is currently taking oral carbamazepine. His EEG reveals mild diffuse instability.
      What is the most probable cause for this EEG finding?

      Your Answer:

      Correct Answer: Antipsychotic medication

      Explanation:

      EEG waveforms may be slightly disrupted by antipsychotic medication, while sporadic Creutzfeldt-Jakob disease (CJD) is linked to specific periodic sharp wave complexes (PSWC) during the middle and late stages of the illness. Generalized seizures would exhibit more pronounced irregularities, whereas temporal lobe epilepsy (TLE) would display anomalous activity originating from a single temporal lobe.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 85 - A community center in a low-income neighborhood notices a rise in delinquent behavior...

    Incorrect

    • A community center in a low-income neighborhood notices a rise in delinquent behavior among teenagers. To address this issue, they implement a comprehensive program aimed at preventing the development of mental health disorders. What type of prevention strategy is being utilized in this community center?

      Your Answer:

      Correct Answer: Indicated prevention

      Explanation:

      The four types of prevention strategies for mental health are indicated, universal, selective, and tertiary. Indicated prevention focuses on individuals who show early signs of biological markers of mental disorder but do not meet diagnostic criteria. Universal prevention targets the general public of a whole population group. Selective prevention targets individuals of subgroups with higher risk factors. Tertiary prevention aims to manage long-term health problems in individuals who already have a mental disorder, with the goal of preventing further deterioration and improving quality of life.

    • This question is part of the following fields:

      • Prevention Of Psychological Disorder
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  • Question 86 - 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 87 - A 72-year-old male reports feeling distressed after hearing his deceased wife's voice in...

    Incorrect

    • A 72-year-old male reports feeling distressed after hearing his deceased wife's voice in his head, asking him to come join her. He clarifies that he heard it internally and not as an external sound. What type of perceptual abnormality is reflected in his experience?

      Your Answer:

      Correct Answer: Pseudohallucinations

      Explanation:

      – Pseudohallucinations are figurative and not real
      – They are located in the inner subjective space
      – Auditory hallucinations are concrete, tangible, and real
      – They are located in the outside objective space
      – Autoscopy is the experience of seeing oneself
      – Reflex hallucination is where a stimulus in one modality produces hallucination in another modality
      – Hypnopompic hallucinations occur when waking up from sleep.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 88 - How can a group of genetic defects causing a single condition be described?...

    Incorrect

    • How can a group of genetic defects causing a single condition be described?

      Your Answer:

      Correct Answer: Heterogeneity

      Explanation:

      Pleiotropy refers to a genetic phenomenon where a single gene has an impact on multiple observable traits. This occurs because the gene produces a product that is utilized by various cells. An instance of pleiotropy is the human condition known as PKU (phenylketonuria).

      Understanding Heterogeneity in Genetic Diseases

      Heterogeneity is a term used to describe the presence of different genetic defects that can cause the same disease. This phenomenon is commonly observed in genetic disorders, where multiple mutations can lead to the same clinical presentation. For instance, the ABO blood group system is an example of heterogeneity, where different combinations of alleles can result in the same blood type.

      Understanding heterogeneity is crucial for accurate diagnosis and treatment of genetic diseases. Identifying the specific genetic defect responsible for a particular disease can help tailor therapies and predict disease progression. However, the presence of heterogeneity can also complicate diagnosis and treatment, as different mutations may require different approaches.

      Overall, heterogeneity highlights the complexity of genetic diseases and underscores the need for personalized medicine approaches that take into account individual genetic variations.

    • This question is part of the following fields:

      • Genetics
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  • Question 89 - How would you describe Broca's aphasia in a speech? ...

    Incorrect

    • How would you describe Broca's aphasia in a speech?

      Your Answer:

      Correct Answer: Non-fluent aphasia

      Explanation:

      Broca’s and Wernicke’s are two types of expressive dysphasia, which is characterized by difficulty producing speech despite intact comprehension. Dysarthria is a type of expressive dysphasia caused by damage to the speech production apparatus, while Broca’s aphasia is caused by damage to the area of the brain responsible for speech production, specifically Broca’s area located in Brodmann areas 44 and 45. On the other hand, Wernicke’s aphasia is a type of receptive of fluent aphasia caused by damage to the comprehension of speech, while the actual production of speech remains normal. Wernicke’s area is located in the posterior part of the superior temporal gyrus in the dominant hemisphere, within Brodmann area 22.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 90 - 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 91 - What is the accurate information about neurasthenia? ...

    Incorrect

    • What is the accurate information about neurasthenia?

      Your Answer:

      Correct Answer: It is still retained as a category in ICD-10 classification

      Explanation:

      In 1869, George Miller Beard introduced the term ‘neurasthenia’ in an article published in the Boston Medical and Surgical Journal. He described anxiety as a key symptom of this condition, which he defined as a lack of nerve force. However, later interpretations of neurasthenia focused more on a state of fatigue and irritability rather than anxiety. While some classification systems have omitted neurasthenia, it remains a commonly used diagnosis in many countries and is still included as a category in ICD-10.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 92 - What is a personality disorder that falls under cluster A? ...

    Incorrect

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

      Your Answer:

      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
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  • Question 93 - What is the most effective depot antipsychotic for preventing psychotic relapse? ...

    Incorrect

    • What is the most effective depot antipsychotic for preventing psychotic relapse?

      Your Answer:

      Correct Answer: Zuclopenthixol decanoate

      Explanation:

      , coma, respiratory depression (rare)

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 94 - At what developmental stage, as described by Piaget, would a 3-year-old child engage...

    Incorrect

    • At what developmental stage, as described by Piaget, would a 3-year-old child engage in symbolic play but struggle with understanding others' perspectives?

      Your Answer:

      Correct Answer: Preoperational

      Explanation:

      The preoperational stage, according to Jean Piaget’s theory of cognitive development, is characterized by children engaging in symbolic play but not yet being able to comprehend logic. Piaget identified four main stages of cognitive development: sensorimotor, preoperational, concrete operational, and formal operational. The sensorimotor stage occurs from birth to two years old, during which the child experiences the world through their senses. The concrete operational stage occurs from seven to eleven years old, during which the child can think logically and is no longer egocentric. The formal operational stage occurs from eleven to sixteen years old, during which the child develops abstract reasoning. It is important to note that the Freudian stage of psychosexual development known as latency is not relevant to Piaget’s theory and is therefore not included in his stages of cognitive development.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 95 - Which option is incorrectly categorized? ...

    Incorrect

    • Which option is incorrectly categorized?

      Your Answer:

      Correct Answer: Olanzapine - Benzoxazole

      Explanation:

      Olanzapine belongs to the thienobenzodiazepine class.

      Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 96 - How does atomoxetine work in the body? ...

    Incorrect

    • How does atomoxetine work in the body?

      Your Answer:

      Correct Answer: Noradrenaline reuptake inhibitor

      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 97 - What is the condition that occurs due to the deterioration of the caudate...

    Incorrect

    • What is the condition that occurs due to the deterioration of the caudate nucleus?

      Your Answer:

      Correct Answer: Huntington's

      Explanation:

      The Basal Ganglia: Functions and Disorders

      The basal ganglia are a group of subcortical structures that play a crucial role in controlling movement and some cognitive processes. The components of the basal ganglia include the striatum (caudate, putamen, nucleus accumbens), subthalamic nucleus, globus pallidus, and substantia nigra (divided into pars compacta and pars reticulata). The putamen and globus pallidus are collectively referred to as the lenticular nucleus.

      The basal ganglia are connected in a complex loop, with the cortex projecting to the striatum, the striatum to the internal segment of the globus pallidus, the internal segment of the globus pallidus to the thalamus, and the thalamus back to the cortex. This loop is responsible for regulating movement and cognitive processes.

      However, problems with the basal ganglia can lead to several conditions. Huntington’s chorea is caused by degeneration of the caudate nucleus, while Wilson’s disease is characterized by copper deposition in the basal ganglia. Parkinson’s disease is associated with degeneration of the substantia nigra, and hemiballism results from damage to the subthalamic nucleus.

      In summary, the basal ganglia are a crucial part of the brain that regulate movement and some cognitive processes. Disorders of the basal ganglia can lead to significant neurological conditions that affect movement and other functions.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 98 - What is an example of an atypical antipsychotic medication? ...

    Incorrect

    • What is an example of an atypical antipsychotic medication?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 99 - The patient's use of words is unclear and may indicate disorganized thinking of...

    Incorrect

    • The patient's use of words is unclear and may indicate disorganized thinking of difficulty expressing themselves. Which of the following best describes this?

      Your Answer:

      Correct Answer: Neologism

      Explanation:

      Neologism pertains to the creation of novel terms, while paraphasia involves the replacement of one word with another, such as saying orange instead of banana. Asyndesis, on the other hand, refers to a breakdown in the distinction between different concepts.

      Formal Thought Disorders

      In formal thought disorders, changes in the speed, coherence, and cogency of thought can be observed from a patient’s speech. These disorders can also be self-reported and may be accompanied by enhanced use of nonverbal language. One possible indication is a lack of an adequate connection between two consecutive thoughts, which is called ‘asyndesis’.

      There are several types of formal thought disorders, including inhibited thinking, retarded thinking, circumstantial thinking, restricted thinking, perseverative thinking, rumination, pressured thinking, flight of ideas, tangential thinking, thought blocking, disruption of thought, incoherence/derailment, and neologisms.

      Inhibited thinking is about the subjective experience of the patient, who may feel that their thinking process is slowed down of blocked by an inner wall of resistance. Retarded thinking, on the other hand, is about the observed quality of thought as inferred through speech, where the flow of thought processes is slowed down and sluggish.

      Circumstantial thinking refers to an inability to separate the essential from the unessential during a conversation without rendering the conversation incoherent. Restricted thinking involves a limited range of thought content, fixation on one particular topic of a small number of topics only, and a stereotyped pattern of thinking.

      Perseverative thinking is characterized by the persistent repetition of previously used words, phrases, of details to the point where they become meaningless in the context of the current stage of the interview. Rumination is the endless mental preoccupation with, of excessive concern over, mostly unpleasant thoughts.

      Pressured thinking, also known as crowding of thought, is when the patient feels helplessly exposed to the pressures of floods of different ideas of thoughts. Flight of ideas involves an increasing multitude of thoughts and ideas which are no longer firmly guided by clear goal-directed thinking.

      Tangential thinking occurs when the patient appears to understand the contents of the questions addressed to them but provides answers which are completely out of context. Thought blocking of disruption of thought refers to sudden disruption of an otherwise normal flow of thought of speech for no obvious reason.

      Incoherence of derailment is when the interviewer is unable to establish sensible connections between the patient’s thinking and verbal output, which is sometimes also called derailment. Neologisms involve the formation of new words of usage of words which disregard normal conventions and are generally not easily understandable.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 100 - In the field of neurology, which specific region of the brain did the...

    Incorrect

    • In the field of neurology, which specific region of the brain did the case of Phineas Gage contribute to our understanding of?

      Your Answer:

      Correct Answer: Frontal lobe

      Explanation:

      The Case of Phineas Gage and the Importance of the Frontal Lobe

      Phineas Gage was a railroad worker who experienced a traumatic accident where an iron pole went through his frontal lobe. Despite surviving the incident, his personality underwent a significant change. This case was crucial in advancing our knowledge of the frontal lobe’s function.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 101 - Acamprosate provides a benefit to individuals with alcohol dependence by acting as an...

    Incorrect

    • Acamprosate provides a benefit to individuals with alcohol dependence by acting as an allosteric modulator at a specific receptor.

      Your Answer:

      Correct Answer: GABA-A

      Explanation:

      Allosteric modulators are substances that bind to a receptor and alter the way the receptor responds to stimuli.

      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 102 - Based on the child's abilities to walk unassisted, stand on their tiptoes, and...

    Incorrect

    • Based on the child's abilities to walk unassisted, stand on their tiptoes, and build a tower of six cubes independently, what would be your estimated age for the child if their development is typical, considering they are unable to sort objects into basic categories?

      Your Answer:

      Correct Answer: 24 months

      Explanation:

      Children typically take their first steps between 9 and 12 months of age, and are typically able to walk independently by around 15 months. At the age of two, children are expected to be able to build a tower of six cubes. Sorting objects into categories is a skill that typically develops around the age of three.

      The Emergence of Social Smiling in Infants

      Wormann (2014) discusses the emergence of social smiling in infants, which is usually interpreted as the first positive expression directed towards a cause. This occurs when an infant with an initially expressionless face examines the face of another person, and their face and eyes light up while the corners of their mouth pull upward. The age of the first appearance of the social smile varies across cultures, ranging from the fifth to seventh week. Additionally, there are differences in its duration and frequency between the second and seventh month of life. Understanding these milestones is important for a basic understanding of normal child development.

      Child Development Milestones:
      4 weeks Responds to noise (either by crying, of quieting), follows an object moved in front of eyes
      6 weeks Begins social smiling*
      3 months Holds head steady on sitting
      6 months Rolls from stomach to back, starts babbling
      7 months Transfers objects from hand to hand, looks for dropped object
      9 months Sits unsupported, begins to crawl
      12 months Cruising (walking by holding furniture)
      18 months Walks without assistance, speaks about 10-20 words
      2 years Runs, climbs up and down stairs alone, makes 2-3 word sentences
      3 years Dresses self except for buttons and laces, counts to 10, feeds themself well
      4 years Hops on one foot, copies a cross
      5 years Copies a triangle, skips

    • This question is part of the following fields:

      • Psychological Development
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  • Question 103 - What is the most common cause of QTc prolongation? ...

    Incorrect

    • What is the most common cause of QTc prolongation?

      Your Answer:

      Correct Answer: Citalopram

      Explanation:

      Citalopram can moderately prolong QTc (>10 msec), while aripiprazole and paliperidone have no effect. Haloperidol and pimozide have a high effect, and quetiapine and amisulpride have a moderate effect. Clozapine, risperidone, and olanzapine have a low effect (<10 msec prolongation). Lamotrigine, mirtazapine, and SSRIs (excluding citalopram) do not have an effect on QTc interval.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 104 - What type of memory failure is typically associated with the inability to remember...

    Incorrect

    • What type of memory failure is typically associated with the inability to remember where one has placed their car keys?

      Your Answer:

      Correct Answer: Absent-mindedness

      Explanation:

      The reason behind absent-mindedness is typically due to insufficient activation of the left inferior prefrontal and parahippocampal regions during the initial encoding process, resulting in shallow processing.

      Memory: Encoding, Storage, Retrieval, and Failure

      Memory is a complex process that involves encoding, storage, and retrieval of information. Encoding refers to how information is placed into memory, and it can be improved by organizing data using techniques such as chunking and mnemonics. Storage refers to keeping information in memory, which can be short-term of long-term. Retrieval refers to getting information back from memory when needed, and it can be affected by primacy and recency effects.

      However, memory is not infallible, and there are seven ways in which it tends to fail. Transience refers to the decreasing accessibility of memory over time, while absent-mindedness is characterized by lapses of attention and forgetting to do things. Blocking is the temporary inaccessibility of stored information, while suggestibility involves the incorporation of misinformation into memory due to leading questions of deception.

      Bias refers to retrospective distortions produced by current knowledge and beliefs, while persistence involves unwanted recollections that people cannot forget, such as the intrusive memories of post-traumatic stress disorder. Finally, misattribution refers to the attribution of memories to incorrect sources of believing that one has seen of heard something that they have not, such as in the case of deja vu of cryptomnesia.

      Overall, memory is a complex and active process that can be affected by various factors, leading to failures in encoding, storage, retrieval, and attribution.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 105 - 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 106 - From which substance is gamma-aminobutyric acid synthesized? ...

    Incorrect

    • From which substance is gamma-aminobutyric acid synthesized?

      Your Answer:

      Correct Answer: Glutamate

      Explanation:

      Glutamate is the precursor for the synthesis of GABA.

      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 107 - What is a true statement about the endocannabinoid system? ...

    Incorrect

    • What is a true statement about the endocannabinoid system?

      Your Answer:

      Correct Answer: CB2 receptors are expressed at much lower levels in the central nervous system compared to CB1

      Explanation:

      The Endocannabinoid System and its Role in Psychosis

      The endocannabinoid system (ECS) plays a crucial role in regulating various physiological functions in the body, including cognition, sleep, energy metabolism, and inflammation. It is composed of endogenous cannabinoids, cannabinoid receptors, and proteins that transport, synthesize, and degrade endocannabinoids. The two best-characterized cannabinoid receptors are CB1 and CB2, which primarily couple to inhibitory G proteins and modulate different neurotransmitter systems in the brain.

      Impairment of the ECS after cannabis consumption has been linked to an increased risk of psychotic illness. However, enhancing the ECS with cannabidiol (CBD) has shown anti-inflammatory and antipsychotic outcomes in both healthy study participants and in preliminary clinical trials on people with psychotic illness of at high risk of developing psychosis. Studies have also found increased anandamide levels in the cerebrospinal fluid and blood, as well as increased CB1 expression in peripheral immune cells of people with psychotic illness compared to healthy controls. Overall, understanding the role of the ECS in psychosis may lead to new therapeutic approaches for treating this condition.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 108 - Which individual is linked to the structural approach in family therapy? ...

    Incorrect

    • Which individual is linked to the structural approach in family therapy?

      Your Answer:

      Correct Answer: Minuchin

      Explanation:

      Family therapy has been shaped by various influential figures, each with their own unique approach. Salvador Minuchin is known for his structural model, which emphasizes the importance of family hierarchy, rules, and boundaries. Gregory Bateson, on the other hand, is associated with paradoxical therapy. Murray Bowen is linked to the family systems approach, while Jay Haley is known for his strategic systemic therapy. Finally, the Milan systemic approach is associated with Mara Selvini Palazzoli. Each of these figures has contributed to the development of family therapy, and their approaches continue to be used and adapted by therapists today.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 109 - What is the most prevalent type of Down's syndrome? ...

    Incorrect

    • What is the most prevalent type of Down's syndrome?

      Your Answer:

      Correct Answer: Trisomy 21

      Explanation:

      Down Syndrome: Causes and Risk Factors

      Down syndrome is a genetic disorder caused by the presence of extra genetic material from chromosome 21. There are three different types of Down syndrome, each with its own cause and inheritance pattern. The most common form, full trisomy 21, is not inherited and accounts for 95% of cases. It occurs when there is a failure of chromosome 21 to separate properly during cell division, resulting in an extra copy of the chromosome. This can happen randomly, with the extra chromosome coming from the mother 88% of the time and from the father 12% of the time.

      The second type, translocation Down syndrome, is inherited and accounts for 2-3% of cases. It occurs when a piece of chromosome 21 breaks off and attaches to another chromosome, resulting in extra genetic material. This type of Down syndrome is caused by a balanced translocation, which means that the parent carrying the translocation has no signs of symptoms of the disorder.

      The third type, mosaic Down syndrome, is not inherited and also accounts for 2-3% of cases. It occurs as a random event during cell division early in fetal development, resulting in some cells having an extra copy of chromosome 21 while others do not.

      The risk of having a child with Down syndrome increases as a mother gets older. At age 35, the risk is 1 in 385; at age 40, the risk is 1 in 106; and at age 45, the risk is 1 in 30. It is important for women to be aware of these risk factors and to discuss them with their healthcare provider if they are planning to have a child.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 110 - In what category of antipsychotics does risperidone fall under? ...

    Incorrect

    • In what category of antipsychotics does risperidone fall under?

      Your Answer:

      Correct Answer: Benzisoxazole

      Explanation:

      Antipsychotics can be classified in various ways, including by chemical structure and generation. The two main generations are typical (first generation) and atypical (second generation) antipsychotics. Risperidone is an atypical antipsychotic and belongs to the benzisoxazole class. It works as an antagonist for dopamine D2, 5-HT 2a, histamine-1 receptor, and alpha 1-adrenoceptor. Other antipsychotics belong to different structural categories, such as butyrophenones (e.g. haloperidol), dibenzodiazapines (e.g. clozapine), dibenzothiazapines (e.g. quetiapine), Thienobenzodiazepine (e.g. olanzapine), phenothiazines (e.g. chlorpromazine, trifluoperazine, thioridazine), thioxanthenes (e.g. flupentixol), diphenylbutylpiperidine (e.g. pimozide), substituted benzamides (e.g. sulpiride), and arylpiperidylindole (quinolone) (e.g. aripiprazole).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 111 - What statement accurately describes the Arizona Sexual Experiences Scale? ...

    Incorrect

    • What statement accurately describes the Arizona Sexual Experiences Scale?

      Your Answer:

      Correct Answer: It can be used in both males and females

      Explanation:

      Antipsychotics and Sexual Dysfunction: Causes, Risks, and Management

      Sexual dysfunction is a common side effect of antipsychotic medication, with the highest risk associated with risperidone and haloperidol due to their effect on prolactin levels. Clozapine, olanzapine, quetiapine, aripiprazole, asenapine, and lurasidone are associated with lower rates of sexual dysfunction. The Arizona Sexual Experiences Scale (ASEX) can be used to measure sexual dysfunction before and during treatment. Management options include excluding other causes, watchful waiting, dose reduction, switching to a lower risk agent, adding aripiprazole, considering an antidote medication, of using sildenafil for erectile dysfunction. It is important to address sexual dysfunction to improve quality of life and medication adherence.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 112 - 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 113 - What is the term used to describe genes that are located close to...

    Incorrect

    • What is the term used to describe genes that are located close to each other on a chromosome and are unlikely to be separated by crossing over?

      Your Answer:

      Correct Answer: Linked

      Explanation:

      Linkage and LOD Scores in Genetics

      In genetics, when genes are located close to each other on a chromosome, they tend to be inherited together and are referred to as linked genes. Conversely, genes that are far apart of located on different chromosomes are inherited independently and are said to follow independent assortment. To determine the relative distance between two genes, scientists can analyze the offspring of an organism that displays two strongly linked traits and calculate the percentage of offspring where the traits do not co-segregate.

      To determine if there is evidence for linkage between two genes, scientists use a statistical method called the LOD score (logarithm of the odds). A LOD score of >3 is considered significant evidence for linkage, while a LOD score of <-2 excludes linkage. The LOD score is calculated by comparing the likelihood of the observed data under the assumption of linkage to the likelihood of the data under the assumption of independent assortment. The LOD score provides a measure of the strength of evidence for linkage between two genes and is widely used in genetic research.

    • This question is part of the following fields:

      • Genetics
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  • Question 114 - What is a known factor that can cause a cleft lip when used...

    Incorrect

    • What is a known factor that can cause a cleft lip when used during pregnancy?

      Your Answer:

      Correct Answer: Diazepam

      Explanation:

      By week 12 of embryonic development, the lip and palate region is usually completely developed. Cleft lip and palate are primarily caused by the use of anticonvulsants, benzodiazepines, and steroids as medications.

      Teratogens and Their Associated Defects

      Valproic acid is a teratogen that has been linked to various birth defects, including neural tube defects, hypospadias, cleft lip/palate, cardiovascular abnormalities, developmental delay, endocrinological disorders, limb defects, and autism (Alsdorf, 2005). Lithium has been associated with cardiac anomalies, specifically Ebstein’s anomaly. Alcohol consumption during pregnancy can lead to cleft lip/palate and fetal alcohol syndrome. Phenytoin has been linked to fingernail hypoplasia, craniofacial defects, limb defects, cerebrovascular defects, and mental retardation. Similarly, carbamazepine has been associated with fingernail hypoplasia and craniofacial defects. Diazepam has been linked to craniofacial defects, specifically cleft lip/palate (Palmieri, 2008). The evidence for steroids causing craniofacial defects is not convincing, according to the British National Formulary (BNF). Selective serotonin reuptake inhibitors (SSRIs) have been associated with congenital heart defects and persistent pulmonary hypertension (BNF). It is important for pregnant women to avoid exposure to these teratogens to reduce the risk of birth defects in their babies.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 115 - At what point does Piaget's formal operational stage commence? ...

    Incorrect

    • At what point does Piaget's formal operational stage commence?

      Your Answer:

      Correct Answer: Logical thinking and hypothesis testing

      Explanation:

      Piaget’s Stages of Development and Key Concepts

      Piaget developed four stages of development that describe how children think and acquire knowledge. The first stage is the Sensorimotor stage, which occurs from birth to 18-24 months. In this stage, infants learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment.

      The second stage is the Preoperational stage, which occurs from 2 to 7 years. During this stage, children use symbols and language more extensively, but they are unable to think logically of deductively. They also use a type of magical thinking and animistic thinking.

      The third stage is the Concrete Operational stage, which occurs from 7 to 11 years. In this stage, egocentric thought is replaced by operational thought, which involves dealing with a wide array of information outside the child. Children in this stage begin to use limited logical thought and can serialise, order, and group things into classes on the basis of common characteristics.

      The fourth and final stage is the Formal Operations stage, which occurs from 11 through the end of adolescence. This stage is characterized by the ability to think abstractly, to reason deductively, to define concepts, and also by the emergence of skills for dealing with permutations and combinations.

      Piaget also developed key concepts, including schema, assimilation, and accommodation. A schema is a category of knowledge and the process of obtaining that knowledge. Assimilation is the process of taking new information into an existing schema, while accommodation involves altering a schema in view of additional information.

      Overall, Piaget’s stages of development and key concepts provide a framework for understanding how children learn and acquire knowledge.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 116 - A teenager presents to A&E in distress. She claims that she has been...

    Incorrect

    • A teenager presents to A&E in distress. She claims that she has been transformed into a wolf by a witch doctor. What type of delusion does this represent?

      Your Answer: