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Question 1
Correct
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For which group of patients is it not recommended to prescribe lithium?
Your Answer: Addison’s disease
Explanation:According to a recent study by Ran (2019), lithium carbonate has been found to have a neuroprotective effect in individuals who have experienced a stroke. The study conducted exploratory analyses of neuroanatomical and cognitive outcomes in a poststroke population. It is interesting to note that while lithium is contraindicated in individuals with Addison’s disease, it is only cautioned in individuals with QT prolongation. Hypothyroidism (untreated) is also a contraindication for lithium. Addison’s disease is a condition characterized by inadequate production of cortisol and aldosterone by the adrenal cortex, leading to symptoms such as fatigue, gastrointestinal abnormalities, changes in skin pigmentation, and mood changes. In some cases, acute adrenal failure can occur, which is a serious condition that develops rapidly. The cause of Addison’s disease is often due to the body’s immune system mistakenly attacking the adrenal glands, causing progressive damage to the adrenal cortex.
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 2
Incorrect
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A 62-year-old man experiences a stroke caused by a ruptured berry aneurysm in the middle cerebral artery, resulting in damage to the temporal lobe. What tests would you anticipate to show abnormalities?
Your Answer: Three object recall
Correct Answer: Copying intersecting pentagons
Explanation:When the parietal lobe is not functioning properly, it can cause constructional apraxia. This condition makes it difficult for individuals to replicate the intersecting pentagons, which is a common cognitive test included in Folstein’s mini-mental state examination.
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This question is part of the following fields:
- Neurosciences
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Question 3
Correct
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When does babbling typically appear during the process of language acquisition?
Your Answer: 6-12 months
Explanation:Linguistic Development and Risk Factors for Delayed Speech and Language
The development of language skills is an important aspect of a child’s growth. The prelinguistic period, from birth to 12 months, is marked by crying, babbling, and echolalia. From 6 to 12 months, a child responds to their name and can differentiate between angry and friendly tones. By 18 to 24 months, a child can use up to 40-50 words, mainly nouns, and starts to combine words in short phrases. By 36 to 48 months, a child has a vocabulary of 900-1000 words, can use plurals and past tense, and can handle three-word sentences easily.
However, there are risk factors associated with delayed speech and language development. These include a positive family history, male gender, twins, lower maternal education, childhood illness, being born late in the family order, young mother at birth, and low socioeconomic status. of these, a positive family history is considered the most reliable risk factor. It is important to monitor a child’s language development and seek professional help if there are concerns about delayed speech and language.
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This question is part of the following fields:
- Psychological Development
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Question 4
Incorrect
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A 30-year-old third generation African American female has just been diagnosed with schizophrenia. Her family is curious about what may have caused her condition. What is the most likely explanation for her schizophrenia?
Your Answer: Schizophrenia is most common in Asian populations
Correct Answer: Migrant workers from certain ethnic minority groups experience increased rates of schizophrenia in the UK
Explanation:Studies have consistently shown that migrant populations have higher rates of schizophrenia, particularly among certain minority ethnic groups. The NICE guidelines on schizophrenia (CG178) have highlighted the importance of investigating social and environmental factors that may increase the risk of developing the illness, such as urban birth and rearing, social adversity and trauma, heavy cannabis use, migration, and stressful life events. Schizophrenia is the most common form of psychotic disorder, with a mean incidence of 0.11 per 1000 (range 0.07-0.17 per 1000) reported in epidemiological studies. The average rates for men and women are similar, but the age of onset is typically 5 years later in women, resulting in a lower female rate during adolescence and a second smaller peak after menopause. The lifetime prevalence of schizophrenia ranges from 0.4 to 1.4%, and a UK survey found a population prevalence of probable psychotic disorder of 5 per 1000 in the age group of 16 to 74 years.
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This question is part of the following fields:
- Stigma And Culture
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Question 5
Incorrect
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Which of the following defense mechanisms has been characterized as a developed coping strategy?
Your Answer: Denial
Correct Answer: Sublimation
Explanation:There are several types of defence mechanisms, including mature, primitive, and intermediate. Mature defence mechanisms are considered healthy and effective ways of coping with emotional stressors. Examples of mature defence mechanisms include humour, suppression, anticipation, altruism, sublimation, and asceticism.
Sublimation is a particularly important mature defence mechanism, as it involves transforming instinctual energies into socially acceptable goals. This can lead to humanitarian and altruistic activities.
On the other hand, primitive defence mechanisms, such as denial, involve ignoring of disavowing that which the conscious cannot tolerate. Intermediate defence mechanisms, such as projection and splitting, involve attributing one’s own undesirable impulses of separating off intolerable aspects of the self.
It’s important to note that not all defence mechanisms are created equal. While mature defence mechanisms can be helpful, primitive and intermediate defence mechanisms can be harmful and may indicate underlying psychological issues.
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This question is part of the following fields:
- Basic Psychological Processes
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Question 6
Correct
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What is accurate about Marcia's stages of development?
Your Answer: Identity diffusion is the least mature status
Explanation:Development: Erikson and Marcia
Erikson’s theory of psychosocial development outlines eight stages of ego growth, each marked by a specific crisis that must be resolved for positive development. These stages range from trust vs. mistrust in infancy to integrity vs. despair in old age. Successful resolution of each crisis leads to positive growth and development.
Marcia expanded on Erikson’s theory, focusing on identity formation during adolescence. He described four separate identity statuses, which represent the four possible combinations of commitment and exploration. Identity confusion/diffusion occurs when adolescents neither explore nor commit to any identities. Foreclosure occurs when an individual commits to an identity without exploring options. A moratorium is a state in which adolescents are actively exploring options but have not yet made commitments. Individuals who have explored different options, discovered their purpose, and have made identity commitments are in a state of identity achievement.
Overall, both Erikson and Marcia’s theories emphasize the importance of positive resolution of developmental crises and the role of exploration and commitment in identity formation.
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This question is part of the following fields:
- Psychological Development
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Question 7
Incorrect
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Which condition is typically associated with a flattened EEG trace?
Your Answer: Sporadic CJD
Correct Answer: Huntington's
Explanation:Electroencephalography
Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.
Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.
Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.
Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.
Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.
Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.
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This question is part of the following fields:
- Neurosciences
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Question 8
Incorrect
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Which individual brought clozapine into clinical use?
Your Answer:
Correct Answer: Kane
Explanation:Imipramine antidepressant effects were discovered by Kuhn. Kane introduced clozapine into clinical practice after conducting a successful double-blind multicenter trial comparing it with chlorpromazine in treatment-resistant schizophrenia. Charpentier synthesized chlorpromazine, while Klein discovered the use of iproniazid. Cade discovered the beneficial effect of lithium in treating mania.
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This question is part of the following fields:
- Psychopharmacology
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Question 9
Incorrect
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Which structure's division results in a condition known as 'split brain'?
Your Answer:
Correct Answer: Corpus callosum
Explanation:The Corpus Callosum and Circle of Willis: Important Structures in the Brain
The corpus callosum is a thick bundle of fibers that connects the two cerebral hemispheres. When this structure is divided, communication between the hemispheres is disrupted, resulting in observable effects through experimental techniques. For instance, if an object is presented to the left visual field only (and therefore processed by the right visual cortex only), a subject may be unable to name the object out loud due to the speech center typically being located in the left hemisphere.
On the other hand, the Circle of Willis is a crucial part of the cerebral circulation. If the optic chiasm is divided, it can lead to specific visual problems known as chiasmal syndrome. These structures play important roles in brain function and can have significant consequences when damaged of disrupted.
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This question is part of the following fields:
- Neurosciences
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Question 10
Incorrect
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Which of the following statements is accurate regarding the symptoms of ADHD?
Your Answer:
Correct Answer: Gonadotropin levels are lowered in anorexia nervosa
Explanation:Anorexia nervosa and bulimia nervosa share similar clinical syndromes, and individuals with eating disorders may transition between the two disorders multiple times. The bulimic subtype of anorexia nervosa involves binge episodes. Anorexia nervosa is more prevalent in females, with a female-to-male ratio of 10:1. Endocrine abnormalities associated with anorexia nervosa include amenorrhea, low levels of gonadotropins (LH and FSH), low levels of estrogen and progesterone, low levels of triiodothyronine, high levels of cortisol, high levels of fasting growth hormone, and irregular vasopressin release.
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This question is part of the following fields:
- Assessment
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Question 11
Incorrect
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Which of the following is an example of a compound question?
Your Answer:
Correct Answer: Do you limit what you eat and exercise to keep thin?
Explanation:Understanding Compound Questions in Interview Techniques
When conducting interviews, it is important to be aware of compound questions. These are questions that combine multiple inquiries into what appears to be a single question. Compound questions can be confusing for the interviewee and may lead to inaccurate of incomplete responses.
To avoid compound questions, it is important to break down inquiries into separate, clear questions. This allows the interviewee to fully understand what is being asked and provide a thoughtful response. Additionally, it is important to avoid using conjunctions such as and of of when asking questions, as this can create compound questions.
By using clear and concise language and avoiding compound questions, interviewers can ensure that they are receiving accurate and complete responses from their interviewees. This can lead to a more successful and informative interview process.
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This question is part of the following fields:
- Classification And Assessment
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Question 12
Incorrect
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What is the frequency of the A allele in a population of 100 diploid individuals, where 30 individuals are heterozygous for allele A and 5 individuals are homozygous for allele A?
Your Answer:
Correct Answer: 0.2
Explanation:Hardy-Weinberg Principle and Allele Frequency
Allele frequency refers to the proportion of a population that carries a specific variant at a particular gene locus. It can be calculated by dividing the number of individual alleles of a certain type by the total number of alleles in a population. The Hardy-Weinberg Principle states that both allele and genotype frequencies in a population remain constant from generation to generation unless specific disturbing influences are introduced. To remain in equilibrium, five conditions must be met, including no mutations, no gene flow, random mating, a sufficiently large population, and no natural selection. The Hardy-Weinberg Equation is used to predict the frequency of alleles in a population, and it can be used to estimate the carrier frequency of genetic diseases. For example, if the incidence of PKU is one in 10,000 babies, then the carrier frequency in the general population is 1/50. Couples with a previous child with PKU have a 25% chance of having another affected child.
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This question is part of the following fields:
- Genetics
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Question 13
Incorrect
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Which topic is associated with the Tarasoff case?
Your Answer:
Correct Answer: Confidentiality
Explanation:Tarasoff Case: Mental Health Professionals’ Duty to Protect
The Tarasoff case was brought before the Supreme Court of California, which ruled that mental health professionals have a responsibility to safeguard individuals who are at risk of physical harm from a patient. This decision has significant implications for the issue of confidentiality in mental health treatment. The court’s ruling establishes that the duty to protect supersedes the duty to maintain confidentiality in situations where a patient poses a threat to others. This case highlights the importance of mental health professionals’ obligation to balance their ethical responsibilities with the safety of their patients and the public.
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This question is part of the following fields:
- Social Psychology
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Question 14
Incorrect
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What are the defining features of Klein's depressive position?
Your Answer:
Correct Answer: Ambivalence
Explanation:Melanie Klein, a prominent psychoanalyst, introduced two significant concepts in her work: the paranoid-schizoid position and the depressive position. The paranoid-schizoid position is a state of mind where the individual perceives the world as fragmented, dividing it into good and bad. This position is characterized by the defense mechanism of splitting, where the individual separates the good and bad aspects of themselves and others.
On the other hand, the depressive position follows the paranoid-schizoid position and is characterized by the ability to accept ambivalence, where something can be both good and bad. This position represents a more integrated state of mind, where the individual can hold conflicting emotions and thoughts simultaneously. These concepts have been influential in psychoanalytic theory and have contributed to our understanding of the human psyche.
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This question is part of the following fields:
- Social Psychology
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Question 15
Incorrect
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How many daughter cells are generated from the meiosis of a single parent cell?
Your Answer:
Correct Answer: 4
Explanation:Cytokinesis: The Final Stage of Cell Division
Cytokinesis is the final stage of cell division, where the cell splits into two daughter cells, each with a nucleus. This process is essential for the growth and repair of tissues in multicellular organisms. In mitosis, cytokinesis occurs after telophase, while in meiosis, it occurs after telophase I and telophase II.
During cytokinesis, a contractile ring made of actin and myosin filaments forms around the cell’s equator, constricting it like a belt. This ring gradually tightens, pulling the cell membrane inward and creating a furrow that deepens until it reaches the center of the cell. Eventually, the furrow meets in the middle, dividing the cell into two daughter cells.
In animal cells, cytokinesis is achieved by the formation of a cleavage furrow, while in plant cells, a cell plate forms between the two daughter nuclei, which eventually develops into a new cell wall. The timing and mechanism of cytokinesis are tightly regulated by a complex network of proteins and signaling pathways, ensuring that each daughter cell receives the correct amount of cytoplasm and organelles.
Overall, cytokinesis is a crucial step in the cell cycle, ensuring that genetic material is equally distributed between daughter cells and allowing for the growth and development of multicellular organisms.
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This question is part of the following fields:
- Genetics
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Question 16
Incorrect
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What is the term used to describe a type of hallucination that occurs during the process of waking up?
Your Answer:
Correct Answer: Hypnopompic
Explanation:Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 17
Incorrect
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What is the definition of copropraxia?
Your Answer:
Correct Answer: Use of obscene gestures
Explanation:Copropraxia is a neurological condition characterized by the involuntary expression of socially unacceptable gestures. It is similar to coprolalia, which is the involuntary expression of socially unacceptable words. Other related conditions include echolalia, which involves copying others’ words, and echopraxia, which involves copying others’ actions. Coprophagia, on the other hand, refers to the act of eating faeces, while palilialia involves repeating one’s own sounds. These conditions can be distressing for those who experience them and can have a significant impact on their daily lives. Treatment options may include medication, therapy, and support groups.
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This question is part of the following fields:
- Classification And Assessment
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Question 18
Incorrect
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Which enzyme is primarily responsible for the metabolism of clozapine?
Your Answer:
Correct Answer: CYP1A2
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 19
Incorrect
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In Freud's topographical model of the mind, which term was not included in his description?
Your Answer:
Correct Answer: Subconscious system
Explanation:Freud’s Topographical Model of the Mind
Freud’s topographical model of the mind, introduced in his book The Interpretation of Dreams, divides the mind into three regions: the conscious system, the preconscious system, and the unconscious system.
The conscious system refers to the part of the mind that is aware. The preconscious system is the information that is known and can potentially be brought into consciousness. Finally, the unconscious system is believed to be outside conscious awareness and operates on primary process thinking, which is aimed at wish fulfillment. It is governed by the pleasure principle, has no concept of time, denies the existence of negatives, and allows the existence of contradictions, making it irrational.
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This question is part of the following fields:
- Social Psychology
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Question 20
Incorrect
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Which component is not considered a key element in Link and Phelan's stigma model?
Your Answer:
Correct Answer: Scapegoating
Explanation:Stigma Models
Stigma refers to any attribute, trait, of disorder that marks an individual as being unacceptably different from the normal people with whom they routinely interact, and that elicits some form of community sanction. The most popular model of stigma comes from the work of Link and Phelan, which has four aspects to it.
The first aspect is labelling, which refers to personal characteristics that mark individuals as different. These characteristics can be physical, mental, of social in nature and can include things like race, gender, sexual orientation, of mental illness.
The second aspect is stereotyping, which involves linking labelled characteristics to undesirable characteristics. For example, people with mental illness may be stereotyped as violent of unpredictable, even though the vast majority of them are not.
The third aspect is separating, which involves separating the labelled group and normal people by viewing them as very different. This can lead to social isolation and exclusion, which can further exacerbate the negative effects of stigma.
The fourth and final aspect is status loss and discrimination, which refers to the devaluing, rejecting, and excluding of the labelled group. This can take many forms, including employment discrimination, housing discrimination, and social exclusion.
Overall, the model of stigma developed by Link and Phelan provides a useful framework for understanding the complex and multifaceted nature of stigma and its effects on individuals and society as a whole.
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This question is part of the following fields:
- Social Psychology
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Question 21
Incorrect
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What is the procedure that entails administering the hepatitis virus to individuals with learning disabilities who are in good health?
Your Answer:
Correct Answer: Willowbrook study
Explanation:Controversial studies in psychiatry have been a popular topic in exams. One such study was the Willowbrook School Study, where healthy children with learning difficulties were inoculated with hepatitis to assess the potential of gamma globulin to treat the disorder. Beecher’s study listed over 20 cases of mainstream research where subjects were experimented on without being fully informed of the risks. The Tuskegee syphilis experiment followed impoverished African-American sharecroppers with syphilis, and a significant proportion did not receive available treatment. Stanford’s prison experiment created a simulated prison environment where participants became their assigned roles, with guards becoming harsh and cruel to prisoners. The Tearooms Study involved Humphreys pretending to be a ‘watch queen’ to study men who have sex in public toilets, raising the issue of informed consent. Milgram’s Study investigated authority and obedience, where participants administered fake shocks to a confederate, with 30 participants continuing to administer shocks until 450 volts was reached. The Rosenhan experiment involved pseudopatients presenting themselves at institutions with the same symptoms and being admitted and diagnosed with serious mental disorders, leading to deinstitutionalisation.
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This question is part of the following fields:
- Social Psychology
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Question 22
Incorrect
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The study involves 341 individuals diagnosed with major depressive episode according to DSM-IV criteria. They are randomly assigned to receive either CBT of psychodynamic psychotherapy, with each treatment consisting of 16 sessions following a manualized protocol over a period of 22 weeks. The participants are initially followed up for 22 weeks and then re-evaluated after one year. What are the probable results of the study?
Your Answer:
Correct Answer: Neither therapy demonstrates superiority at any point in the trial
Explanation:Recent clinical trials have shown that various psychotherapy approaches do not differ significantly in terms of effectiveness. This particular trial aimed to prove that psychodynamic psychotherapy was not inferior to other modalities at 22 weeks and one year follow-up. While non-inferiority was observed at 22 weeks, it could not be conclusively demonstrated at one year, despite no significant difference between interventions. Interestingly, individuals who received CBT appeared to require more additional treatment during the year following therapy, although this trend was not statistically significant.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 23
Incorrect
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What is a licensed treatment for bulimia nervosa?
Your Answer:
Correct Answer: Fluoxetine
Explanation:Antidepressants (Licensed Indications)
The following table outlines the specific licensed indications for antidepressants in adults, as per the Maudsley Guidelines and the British National Formulary. It is important to note that all antidepressants are indicated for depression.
– Nocturnal enuresis in children: Amitriptyline, Imipramine, Nortriptyline
– Phobic and obsessional states: Clomipramine
– Adjunctive treatment of cataplexy associated with narcolepsy: Clomipramine
– Panic disorder and agoraphobia: Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine
– Social anxiety/phobia: Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine
– Generalised anxiety disorder: Escitalopram, Paroxetine, Duloxetine, Venlafaxine
– OCD: Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Clomipramine
– Bulimia nervosa: Fluoxetine
– PTSD: Paroxetine, Sertraline -
This question is part of the following fields:
- Psychopharmacology
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Question 24
Incorrect
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What was the conditioned stimulus in Pavlov's conditioning experiments?
Your Answer:
Correct Answer: The ringing of the bell
Explanation:Classical Conditioning: A Learning Theory by Ivan Pavlov
Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.
Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.
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This question is part of the following fields:
- Social Psychology
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Question 25
Incorrect
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What is the preferred antidepressant for individuals experiencing depression after a heart attack?
Your Answer:
Correct Answer: Sertraline
Explanation:Sertraline is the preferred medication for treating post-MI depression as it has minimal impact on heart rate, blood pressure, and the QTc interval. Tricyclics are not recommended due to their potential to cause postural hypotension, increased heart rate, and QTc interval prolongation. Fluoxetine may be used with caution as it has a slight effect on heart rate but does not significantly affect blood pressure of the QTc interval. Trazodone should be used with care as it can cause significant postural hypotension and QTc interval prolongation in post-MI patients. Venlafaxine should be avoided in these patients as it can increase blood pressure, particularly at higher doses.
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This question is part of the following fields:
- Psychopharmacology
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Question 26
Incorrect
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A 30-year-old male with a history of depression is interested in trying agomelatine as a potential treatment. Can you explain the mechanism of action of agomelatine?
Your Answer:
Correct Answer: MT1 and MT2 receptor agonist
Explanation:Agomelatine acts as a melatonergic agonist at MT1 and MT2 receptors and also as a 5-HT2C antagonist, indirectly increasing norepinephrine and dopamine levels to alleviate depression. Moclobemide, an MAO-A inhibitor, boosts serotonin, dopamine, and norepinephrine levels in the brain, resulting in antidepressant effects. Fluoxetine, a selective serotonin reuptake inhibitor, elevates serotonin levels, while venlafaxine, a serotonin and norepinephrine reuptake inhibitor, enhances the concentration of both chemicals in the brain, leading to antidepressant benefits.
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This question is part of the following fields:
- Psychopharmacology
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Question 27
Incorrect
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What is a true statement about attachment theory?
Your Answer:
Correct Answer: The primary attachment figure is not necessarily the mother
Explanation:Attachment Theory and Harlow’s Monkeys
Attachment theory, developed by John Bowlby, suggests that children have an innate tendency to form relationships with people around them to increase their chance of survival. This attachment is different from bonding, which concerns the mother’s feelings for her infant. Children typically single out a primary caregiver, referred to as the principle attachment figure, from about 1-3 months. The quality of a person’s early attachments is associated with their adult behavior, with poor attachments leading to withdrawn individuals who struggle to form relationships and good attachments leading to socially competent adults who can form healthy relationships.
Bowlby’s attachment model has four stages: preattachment, attachment in the making, clear-cut attachment, and formation of reciprocal attachment. The time from 6 months to 36 months is known as the critical period, during which a child is most vulnerable to interruptions in its attachment. Attachments are divided into secure and insecure types, with insecure types further divided into avoidant and ambivalent types.
Harlow’s experiment with young rhesus monkeys demonstrated the importance of the need for closeness over food. The experiment involved giving the monkeys a choice between two different mothers, one made of soft terry cloth but provided no food and the other made of wire but provided food from an attached baby bottle. The baby monkeys spent significantly more time with their cloth mother than with their wire mother, showing the importance of attachment and closeness in early development.
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This question is part of the following fields:
- Psychological Development
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Question 28
Incorrect
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Which antibiotic may have anti-inflammatory and neuroprotective effects and could be used in combination with clozapine to treat schizophrenia that is resistant to other treatments?
Your Answer:
Correct Answer: Minocycline
Explanation:There is evidence to suggest that minocycline has anti-inflammatory and neuroprotective properties. Additionally, both an open study and a randomized controlled trial indicate that it may have positive effects on cognitive and negative symptoms.
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This question is part of the following fields:
- Psychopharmacology
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Question 29
Incorrect
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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.
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This question is part of the following fields:
- Neurosciences
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Question 30
Incorrect
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What assessment tool would be most suitable for determining if a 55-year-old patient with Down's syndrome is showing signs of Alzheimer's disease?
Your Answer:
Correct Answer: DLD
Explanation:The CAMDEX assessment is not effective in detecting dementia in adults with learning disabilities, whose developmental ages are typically between 2 and 10 years. However, the Dementia Questionnaire for People with Learning Disabilities (DLD) is a useful tool for early detection of dementia in this population. For individuals with Down’s syndrome, an adapted version of the CAMDEX called the CAMDEX-DS can be utilized.
Assessment of Dementia in Down’s Syndrome
Individuals with Down’s syndrome are at a higher risk of developing Alzheimer’s disease. However, the commonly used MMSE test is not effective in assisting diagnosis in this population. Instead, two alternative tests are recommended: the Dementia Questionnaire for people with Learning Disabilities (DLD), previously known as the Dementia Questionnaire for Persons with Mental Retardation (DMR), and the Dementia Scale for Down Syndrome (DSDS). These tests are specifically designed to assess cognitive decline in individuals with Down’s syndrome and can aid in the early detection and management of dementia in this population.
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This question is part of the following fields:
- Psychological Development
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Question 31
Incorrect
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Acamprosate is believed to produce its positive effects in the treatment of alcohol dependence by targeting which type of receptors?
Your Answer:
Correct Answer: Metabotropic glutamate receptors
Explanation:The exact way in which acamprosate helps maintain alcohol abstinence is not fully understood. However, it is believed that chronic alcohol exposure disrupts the balance between neuronal excitation and inhibition. Studies conducted on animals suggest that acamprosate may interact with the glutamate and GABA neurotransmitter systems in the brain, which may help restore this balance. Acamprosate is thought to inhibit glutamate receptors while activating GABA receptors, specifically GABA-A and metabotropic glutamate receptors. It should be noted that some sources suggest that acamprosate affects NMDA receptors, which are a type of ionotropic glutamate receptor. However, this is not entirely accurate and may not be reflected in exam questions.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 32
Incorrect
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What is the accurate statement about the dispensation of medication in older adults?
Your Answer:
Correct Answer: As people age, the half-life of a lipid soluble drug increases
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 33
Incorrect
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What condition is most commonly associated with slow (<2.5 Hz) generalized spike-and-wave discharges on the EEG?
Your Answer:
Correct Answer: Atypical absence seizures
Explanation:Electroencephalography
Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.
Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.
Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.
Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.
Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.
Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.
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This question is part of the following fields:
- Neurosciences
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Question 34
Incorrect
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You are requested to evaluate a young adult who has ingested a toxic amount of medication. In terms of your evaluation, which of the following statements is accurate?
Your Answer:
Correct Answer: If the patient has a family history of suicide they are more likely to die by suicide themselves
Explanation:Risk Factors for Suicide
A family history of suicide is a significant risk factor for suicide, even if there is no family history of psychiatric disorder. Asking someone about suicidal thoughts does not cause them to have those thoughts, and individuals who self-harm regularly are at a higher risk of suicide. In fact, studies have shown that 1-6% of individuals who present to the hospital after non-fatal self-poisoning of self-injury die by suicide within the first year. It is also important to note that 90% of people who die by suicide have a psychiatric disorder. These risk factors should be taken seriously and addressed in order to prevent suicide.
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This question is part of the following fields:
- History And Mental State
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Question 35
Incorrect
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A teenager has a delusional belief that he is the son of god. He remains in touch with reality and incorporates actual facts into his delusional belief system. What is the most appropriate term to describe the structure of his delusion?
Your Answer:
Correct Answer: Polarised
Explanation:The structure of a delusion is not described by the term grandiose, but rather the content.
Delusional Structure
Delusions can be categorized based on their logical consistency and organization. Logical delusions are consistent with logical thinking, while paralogical delusions are not. Delusions can also be organized, integrated into a formed concept, of unorganized. Highly organized, logical delusions are referred to as systematized.
The relationship between delusional beliefs and reality can also be described in different ways. Polarized delusions mix fact and delusion together, while juxtaposed delusions exist side by side with facts but do not interact. Autistic delusions completely disregard actual reality, and the patient lives in a delusional world.
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This question is part of the following fields:
- Classification And Assessment
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Question 36
Incorrect
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What substance has a comparable impact to khat?
Your Answer:
Correct Answer: Amphetamine
Explanation:For centuries, individuals from the East coast of Africa have been chewing khat, which produces effects that stem from two phenylalkylamines, cathinone and cathine, both of which are structurally similar to amphetamine. The physical effects of khat include dry mouth, dizziness, impotence, cirrhosis, tachycardia, and tachypnoea.
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This question is part of the following fields:
- Psychopharmacology
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Question 37
Incorrect
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What characteristic is commonly observed in individuals originating from West Africa?
Your Answer:
Correct Answer: Brain fag
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 38
Incorrect
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Which of the following is an example of a non-fluent aphasia?
Your Answer:
Correct Answer: Broca's aphasia
Explanation:Aphasia is a language impairment that affects the production of comprehension of speech, as well as the ability to read of write. The areas involved in language are situated around the Sylvian fissure, referred to as the ‘perisylvian language area’. For repetition, the primary auditory cortex, Wernicke, Broca via the Arcuate fasciculus (AF), Broca recodes into articulatory plan, primary motor cortex, and pyramidal system to cranial nerves are involved. For oral reading, the visual cortex to Wernicke and the same processes as for repetition follows. For writing, Wernicke via AF to premotor cortex for arm and hand, movement planned, sent to motor cortex. The classification of aphasia is complex and imprecise, with the Boston Group classification and Luria’s aphasia interpretation being the most influential. The important subtypes of aphasia include global aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, anomic aphasia, transcortical motor aphasia, and transcortical sensory aphasia. Additional syndromes include alexia without agraphia, alexia with agraphia, and pure word deafness.
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This question is part of the following fields:
- Neurosciences
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Question 39
Incorrect
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A pediatrician wants to assess the pain levels in his young patients with sickle cell disease. He is uncertain if the children are able to rate their pain accurately and prefers a scale that can be rated by either him of the caregiver. What rating scale would be most suitable for his purposes?
Your Answer:
Correct Answer: Rating of medication influences (ROMI)
Explanation:Several scales are available to measure medication adherence attitudes and behaviors in psychiatric patients, particularly those with schizophrenia. The Rating of Medication Influences (ROMI) scale has 20 interviewer-rated items with good inter-rater reliability. The ASK-20 Adherence Barrier Survey measures barriers to adherence with 20 clinical items. The Brief Evaluation of Medication Influences and Beliefs (BEMIB) scale is an eight-item Likert-type scale that measures costs and benefits of medication use based on the health belief model. The Drug Attitude Inventory is a 30-item self-report scale that evaluates subjective effects of antipsychotic drugs among patients with schizophrenia. The Medication Adherence Rating Scale (MARS) is a 10-item self-report scale derived from the Drug Attitude Inventory and Medication Adherence Questionnaire, and is used in patients with schizophrenia and psychosis.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 40
Incorrect
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John is a 35-year-old businessman. He is seeking therapy for his anxiety and the therapist is struggling to understand his constant need for attention and validation. They are also confused by his rapid mood swings, going from feeling hopeless and defeated to being overly confident and grandiose. He often shows up to sessions in flashy clothing and talks about his accomplishments and successes. His wife mentions that he has always been this way and that his charisma was what initially attracted her to him.
What is the probable diagnosis?Your Answer:
Correct Answer: Histrionic personality disorder
Explanation:John’s behavior is causing distress and impairment in his ability to participate in family therapy and may have contributed to his child’s depression. His behavior is consistent with histrionic personality disorder, which is only found in the ICD-10. This disorder is characterized by self-dramatization, exaggerated emotions, suggestibility, a shallow and unstable emotional state, a constant need for attention and excitement, inappropriate seductive behavior, and an excessive concern with physical appearance. Other associated features may include egocentricity, self-indulgence, a constant desire for appreciation, easily hurt feelings, and manipulative behavior to meet personal needs.
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This question is part of the following fields:
- Diagnosis
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Question 41
Incorrect
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What is the OTC medication that poses the highest risk of a severe interaction with an MAOI antidepressant?
Your Answer:
Correct Answer: Chlorphenamine
Explanation:Chlorphenamine, also known as Piriton, is classified as a first-generation antihistamine that functions by obstructing the H1 receptor. This sedative antihistamine is utilized to treat allergic conditions like hay fever. Additionally, it is present in certain cough medicines as it reduces the production of mucus.
MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions
First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).
MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.
The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.
Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.
Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).
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This question is part of the following fields:
- Psychopharmacology
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Question 42
Incorrect
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What does Bazett's formula correct for when deriving the corrected QT interval from the QT interval?
Your Answer:
Correct Answer: Heart rate
Explanation:Bazett’s formula adjusts the QT interval to account for variations in heart rate.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 43
Incorrect
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During the examination of a male patient with schizophrenia, the physician observed that his right hand could be easily moved with minimal pressure. Can you identify this phenomenon?
Your Answer:
Correct Answer: Mitgehen
Explanation:Schizophrenia can present with various motor disorders, which can be observed during interactions with the interviewer. These may include excessive cooperation of opposition. Symptoms of excessive cooperation include mitgehen, echopraxia, automatic obedience, and advertence. Mitgehen is characterized by abnormal movements in response to the interviewer’s direction. Echopraxia involves the patient imitating the interviewer’s movements. Automatic obedience is when the patient follows commands in a literal and concrete manner. Advertence is when the patient turns towards the examiner in response to bizarre, exaggerated, and inflexible speech.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 44
Incorrect
-
What is a true statement about Levinson's theory of human development?
Your Answer:
Correct Answer: Stages are based on age ranges rather than on developmental events
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.
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This question is part of the following fields:
- Psychological Development
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Question 45
Incorrect
-
Which ability is not included in Thurstone's list of primary abilities?
Your Answer:
Correct Answer: Working memory
Explanation:The WAIS includes working memory as a component, but it is not considered a fundamental skill.
Thurstone’s Theory of Intelligence
Louis Leon Thurstone believed that intelligence could not be reduced to a single factor. Instead, he proposed that intelligence is composed of seven distinct abilities, which he called the primary abilities. These abilities include word fluency, verbal comprehension, spatial visualization, number facility, associative memory, reasoning, and perceptual speed. According to Thurstone, each of these abilities is independent of the others and contributes to an individual’s overall intelligence. This theory challenged the prevailing view of intelligence at the time, which held that intelligence could be measured by a single factor known as the g factor. Thurstone’s theory has had a lasting impact on the field of psychology and has influenced the development of modern intelligence tests.
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This question is part of the following fields:
- Social Psychology
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Question 46
Incorrect
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What is the synonym for consequentialism?
Your Answer:
Correct Answer: Teleology
Explanation:Teleology, derived from the Greek words for goal and theory, is a moral philosophy that emphasizes the outcomes of actions as the initial consideration in evaluating ethical behavior. This category of theories is also known as consequentialism, as it focuses on the consequences of an action as the basis for determining its morality. Consequentialism evaluates the morality of an action based on the balance of its positive and negative outcomes. Utilitarianism of social consequentialism is the most prevalent form of consequentialism, although it is not the only one.
Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.
More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.
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This question is part of the following fields:
- Social Psychology
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Question 47
Incorrect
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What is the beverage with the highest caffeine content per serving size?
Your Answer:
Correct Answer: Brewed coffee
Explanation:The caffeine content in brewed coffee is relatively high, with approximately 100 mg per cup. In comparison, tea has a lower caffeine content. Black tea has around 45 mg per cup, while green tea has approximately 25 mg per cup. Instant coffee contains about 60 mg per cup, and a can of Red Bull contains 80 mg of caffeine.
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This question is part of the following fields:
- Psychopharmacology
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Question 48
Incorrect
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During which stages of Tanner development do males experience their growth spurt?
Your Answer:
Correct Answer:
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.
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This question is part of the following fields:
- Psychological Development
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Question 49
Incorrect
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Which substance follows zero order kinetics during metabolism?
Your Answer:
Correct Answer: Phenytoin
Explanation:The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.
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This question is part of the following fields:
- Psychopharmacology
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Question 50
Incorrect
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Which of the following is not an inducer of the Cytochrome P450 system?
Your Answer:
Correct Answer: Fluoxetine
Explanation:Cytochrome P450 is an important enzyme system involved in drug metabolism. Certain substances can either increase or decrease the activity of this system. Smoking, alcohol, barbiturates, carbamazepine, Phenytoin, and St John’s Wort are known to induce the activity of cytochrome P450. On the other hand, chlorpromazine, selective serotonin reuptake inhibitors (SSRIs), and grapefruit juice are known to inhibit the activity of cytochrome P450.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 51
Incorrect
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You are consulting with a 16-year-old girl in your office alongside a nurse. She has been experiencing difficulties with managing her anger and reveals to you that she was taken to her home country in North Africa by her grandmother during the last summer break. She is hesitant to discuss the matter further with her mother present. However, when you speak with her alone, she discloses that she was subjected to female genital mutilation (FGM) without her consent during this trip. What is the legal stance on FGM?
Your Answer:
Correct Answer: It is illegal in the UK and illegal to arrange for a child to be taken out of the UK to have FGM
Explanation:FGM is against the law in the UK, and arranging for a child to undergo the procedure abroad is also illegal. Those who are caught can face a prison sentence of up to 14 years and a hefty fine. Shockingly, it is estimated that 66,000 women in the UK have already undergone FGM, and over 20,000 girls under the age of 15 are at risk. Often, children are taken to have the procedure during the summer holidays so that they have time to heal before returning to school. There are four main types of FGM, including clitoridectomy, excision, infibulation, and other harmful procedures such as pricking, piercing, cutting, scraping, and burning the genital area. FGM is carried out for cultural, religious, and social reasons and is most prevalent in Africa, although it also occurs in Asia and the Middle East. The experience can be extremely traumatic, and those who have undergone FGM may require counseling in the future. Recently, medical professionals have faced criminal prosecution for allegedly performing the procedure, which is illegal in the UK.
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This question is part of the following fields:
- Stigma And Culture
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Question 52
Incorrect
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Which of the following refers to a continuous stream of slow, flowing, writhing involuntary movements?
Your Answer:
Correct Answer: Athetosis
Explanation:Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 53
Incorrect
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A 17-year-old girl is involved in a car crash and is experiencing internal bleeding. She has no identified emergency contact and is declining medical intervention. As she is unable to provide consent, what options are available for her treatment?
Your Answer:
Correct Answer: Common law
Explanation:Legal Principles and Acts Related to Mental Capacity and Treatment
A common law principle is a legal concept that is recognized and enforced by courts based on societal customs. The doctrine of necessity allows for the use of reasonable force and necessary treatment for individuals who lack capacity and are in their best interests.
The Mental Capacity Act Deprivation of Liberty Safeguards (DoLS) provides protection for vulnerable individuals who lack capacity and are in hospitals of care homes. It applies to those who are 18 and over, have a mental disorder of disability of the mind, and cannot give informed consent for their care of treatment.
The Mental Capacity Act 2005 governs decision-making for individuals who may lose capacity of have an incapacitating condition. It applies to those aged 16 and over who cannot make some of all decisions for themselves.
Children who understand proposed treatments are considered competent to give consent (Gillick competent). The Mental Health Act 1983 covers the compulsory assessment and treatment of individuals with mental disorders.
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This question is part of the following fields:
- Basic Ethics And Philosophy Of Psychiatry
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Question 54
Incorrect
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While on a weekend pass to visit his family, a middle-aged man with bipolar disorder destroys his sister's car.
When asked about his behavior, he explains that he saw a black cat cross his path and knew he had to destroy something to ward off bad luck.
What is this an instance of?Your Answer:
Correct Answer: Delusional percept
Explanation:Delusional perceptions involve attaching a delusional meaning to an accurate perception, which can feel like a significant realization. This differs from interpreting accurate perceptions in a way that aligns with pre-existing delusions. These perceptions are considered a primary symptom.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 55
Incorrect
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A 30-year-old woman is experiencing sudden anxiety and has a belief that her body is shrinking. What is the probable culture-bound syndrome?
Your Answer:
Correct Answer: Koro
Explanation:Koro is a syndrome that mainly affects individuals in Africa and Asia, causing them to believe that their genitals are retracting and will disappear, despite no actual physical changes. Dhat syndrome, prevalent in India, is characterized by symptoms such as fatigue, weakness, anxiety, and sexual dysfunction, with patients believing they are passing semen in their urine. Kuru is a neurological disorder, while Latah, found in Southeast Asia, is similar to Tourette’s syndrome. Piblokto, observed in Inuits, is a sudden dissociative state that results in loss of consciousness during the attack and amnesia afterwards.
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This question is part of the following fields:
- Stigma And Culture
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Question 56
Incorrect
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What mechanism is believed to be responsible for the weight gain induced by antipsychotic medications?
Your Answer:
Correct Answer: Histamine receptor antagonist
Explanation:Side Effects of Psychotropic Drugs (Receptor Based)
The use of psychotropic drugs can lead to various side effects, which are often receptor-based. Some of the most common side effects are listed below:
Antidopaminergic Effects: These effects include galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.
Anticholinergic Central M1: This can cause memory impairment and confusion.
Anticholinergic Peripheral M1: This can lead to dry mouth, blurred vision, glaucoma, sinus tachycardia, urinary retention, and constipation.
Histaminergic H1: This can result in weight gain and sedation.
Adrenergic Alpha 1 Antagonist: This can cause orthostatic hypotension, sexual dysfunction, and sedation.
5HT2a and 5-HT2c Antagonism: This can lead to weight gain.
It is important to note that these are just some of the more common side effects and that individuals may experience different side effects depending on their unique physiology and the specific drug they are taking. It is always important to discuss any concerns of side effects with a healthcare provider.
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This question is part of the following fields:
- Psychopharmacology
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Question 57
Incorrect
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What screening tool does NICE recommend for identifying alcohol misuse?
Your Answer:
Correct Answer: AUDIT
Explanation:Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 58
Incorrect
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A woman comes to the clinic with a sudden loss of vision in both eyes. There are no abnormalities in the front part of the eye of the back part of the eye, and her pupils react normally to light. What is the most probable location of the blockage in the artery?
Your Answer:
Correct Answer: Posterior cerebral arteries
Explanation:Bilateral infarction in the territory supplied by the distal posterior cerebral arteries can lead to cortical blindness with preserved pupillary reflex. This condition is often accompanied by Anton’s syndrome, where patients are unaware of their blindness.
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This question is part of the following fields:
- Neurosciences
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Question 59
Incorrect
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Who coined the term 'punch drunk syndrome'?
Your Answer:
Correct Answer: Martland
Explanation:Dementia Pugilistica: A Neurodegenerative Condition Resulting from Neurotrauma
Dementia pugilistica, also known as chronic traumatic encephalopathy (CTE), is a neurodegenerative condition that results from neurotrauma. It is commonly seen in boxers and NFL players, but can also occur in anyone with neurotrauma. The condition is characterized by symptoms such as gait ataxia, slurred speech, impaired hearing, tremors, disequilibrium, neurobehavioral disturbances, and progressive cognitive decline.
Most cases of dementia pugilistica present with early onset cognitive deficits, and behavioral signs exhibited by patients include aggression, suspiciousness, paranoia, childishness, hypersexuality, depression, and restlessness. The progression of the condition leads to more prominent behavioral symptoms such as difficulty with impulse control, irritability, inappropriateness, and explosive outbursts of aggression.
Neuropathological abnormalities have been identified in CTE, with the most unique feature being the abnormal accumulation of tau in neurons and glia in an irregular, focal, perivascular distribution and at the depths of cortical sulci. Abnormalities of the septum pellucidum, such as cavum and fenestration, are also a common feature.
While the condition has become increasingly rare due to the progressive improvement in sports safety, it is important to recognize the potential long-term consequences of repeated head injuries and take steps to prevent them.
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This question is part of the following fields:
- Neurosciences
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Question 60
Incorrect
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Which of the following statements is most in line with the International Classification of Diseases (ICD-11) guidelines?
Your Answer:
Correct Answer: International classification of diseases uses the term mental disorder
Explanation:Classification of Diseases: A Brief Overview
A scientific classification system should have standardized names, clear operational criteria, and a multiaxial arrangement for citing important attributes. The International Classification of Diseases (ICD) has been the main nosologic system for identifying human ailments for the past century. It has a well-organized and widely accepted nomenclature, but lacks operational criteria and an appropriate multiaxial pattern. The ICD-10 is available in major languages and classifies psychiatric conditions under Mental and behavioural disorders in Chapter V. However, it does not include social consequences of the disorder, which is included in the DSM IV under Axis 4 (Psychosocial and Environmental Problems). Neurasthenia is classified under Other neurotic disorders (F48.0) in the ICD-10. Overall, classification of diseases is a system of categories to which morbid entities are assigned according to established criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 61
Incorrect
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A 30-year-old woman is diagnosed with damage to the Broca's area after experiencing expressive aphasia following a car accident. Where is the Broca's area located in the brain?
Your Answer:
Correct Answer: Inferior frontal gyrus
Explanation:Broca’s area, located in the inferior frontal gyrus of the dominant hemisphere, is a crucial region for language production. It controls the motor functions necessary for speech production, and damage to this area can result in difficulties forming words and speaking. While language comprehension remains intact, the individual may experience expressive dysphasia, struggling to produce speech.
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This question is part of the following fields:
- Neurosciences
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Question 62
Incorrect
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Zopiclone is thought to exert its effects by targeting which type of receptor?
Your Answer:
Correct Answer: GABA
Explanation:Benzodiazepines and Z-drugs (such as zopiclone and zolpidem) have a common mechanism of action on the GABA receptor. It is noteworthy that alcohol also affects this receptor, which explains the similar effects observed in alcohol and benzodiazepine use. Additionally, benzodiazepines play a role in managing alcohol withdrawal symptoms.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 63
Incorrect
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A young adult presents with a 2 year history of an unusual movement disorder associated with memory problems. He denies any past psychiatric history but does recall that one of his parents died early from a similar movement problem. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Huntington's disease
Explanation:Huntington’s Disease: Genetics and Pathology
Huntington’s disease is a genetic disorder that follows an autosomal dominant pattern of inheritance. It is caused by a mutation in the Huntington gene, which is located on chromosome 4. The mutation involves an abnormal expansion of a trinucleotide repeat sequence (CAG), which leads to the production of a toxic protein that damages brain cells.
The severity of the disease and the age of onset are related to the number of CAG repeats. Normally, the CAG sequence is repeated less than 27 times, but in Huntington’s disease, it is repeated many more times. The disease shows anticipation, meaning that it tends to worsen with each successive generation.
The symptoms of Huntington’s disease typically begin in the third of fourth decade of life, but in rare cases, they can appear in childhood of adolescence. The most common symptoms include involuntary movements (chorea), cognitive decline, and psychiatric disturbances.
The pathological hallmark of Huntington’s disease is the gross bilateral atrophy of the head of the caudate and putamen, which are regions of the brain involved in movement control. The EEG of patients with Huntington’s disease shows a flattened trace, indicating a loss of brain activity.
Macroscopic pathological findings include frontal atrophy, marked atrophy of the caudate and putamen, and enlarged ventricles. Microscopic findings include neuronal loss and gliosis in the cortex, neuronal loss in the striatum, and the presence of inclusion bodies in the neurons of the cortex and striatum.
In conclusion, Huntington’s disease is a devastating genetic disorder that affects the brain and causes a range of motor, cognitive, and psychiatric symptoms. The disease is caused by a mutation in the Huntington gene, which leads to the production of a toxic protein that damages brain cells. The pathological changes in the brain include atrophy of the caudate and putamen, neuronal loss, and the presence of inclusion bodies.
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This question is part of the following fields:
- Genetics
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Question 64
Incorrect
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What are the factors that contribute to interpersonal attraction? Please rephrase the question if necessary.
Your Answer:
Correct Answer: Proximity is important
Explanation:There are several factors that can make people more likely to be attracted to each other, including being close in proximity, having familiarity with each other, sharing similar interests and values, being exposed to each other frequently, perceiving each other as competent, experiencing mutual liking, engaging in self-disclosure, and being physically attractive.
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This question is part of the following fields:
- Basic Psychological Processes
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Question 65
Incorrect
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Which substance has the greatest amount of time required for half of its atoms to decay?
Your Answer:
Correct Answer: Diazepam
Explanation:Benzodiazepines are a class of drugs commonly used to treat anxiety and sleep disorders. It is important to have a working knowledge of the more common benzodiazepines and their half-life. Half-life refers to the amount of time it takes for half of the drug to be eliminated from the body.
Some of the more common benzodiazepines and their half-life include diazepam with a half-life of 20-100 hours, clonazepam with a half-life of 18-50 hours, chlordiazepoxide with a half-life of 5-30 hours, nitrazepam with a half-life of 15-38 hours, temazepam with a half-life of 8-22 hours, lorazepam with a half-life of 10-20 hours, alprazolam with a half-life of 10-15 hours, oxazepam with a half-life of 6-10 hours, zopiclone with a half-life of 5-6 hours, zolpidem with a half-life of 2 hours, and zaleplon with a half-life of 2 hours. Understanding the half-life of these drugs is important for determining dosages and timing of administration.
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This question is part of the following fields:
- Psychopharmacology
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Question 66
Incorrect
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Which condition is inherited in an autosomal dominant pattern?
Your Answer:
Correct Answer: Huntington's disease
Explanation:Inheritance Patterns and Examples
Autosomal Dominant:
Neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, and Noonan’s syndrome are all examples of conditions that follow an autosomal dominant inheritance pattern. This means that only one copy of the mutated gene is needed to cause the condition.Autosomal Recessive:
Phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, and cystic fibrosis are all examples of conditions that follow an autosomal recessive inheritance pattern. This means that two copies of the mutated gene are needed to cause the condition.X-Linked Dominant:
Vitamin D resistant rickets and Rett syndrome are examples of conditions that follow an X-linked dominant inheritance pattern. This means that the mutated gene is located on the X chromosome and only one copy of the gene is needed to cause the condition.X-Linked Recessive:
Cerebellar ataxia, Hunter’s syndrome, and Lesch-Nyhan are examples of conditions that follow an X-linked recessive inheritance pattern. This means that the mutated gene is located on the X chromosome and two copies of the gene are needed to cause the condition.Mitochondrial:
Leber’s hereditary optic neuropathy and Kearns-Sayre syndrome are examples of conditions that follow a mitochondrial inheritance pattern. This means that the mutated gene is located in the mitochondria and is passed down from the mother to her offspring. -
This question is part of the following fields:
- Genetics
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Question 67
Incorrect
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Which of the following is not a component of the syndrome of frontotemporal lobe degeneration (FTLD)?
Your Answer:
Correct Answer: Posterior cortical atrophy
Explanation:Frontotemporal lobe degeneration (FTLD) encompasses various syndromes, such as Pick’s disease, primary progressive aphasia (which impacts speech), semantic dementia (affecting conceptual knowledge), and corticobasal degeneration (characterized by asymmetrical akinetic-rigid syndrome and apraxia). It is important to note that posterior cortical atrophy, which involves tissue loss in the posterior regions and affects higher visual processing, is not considered a part of the FTLD syndrome.
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This question is part of the following fields:
- Neurosciences
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Question 68
Incorrect
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You are sitting in class during a test. You realize you forgot to study and you feel anxious. Which emotional theory best explains this experience?
Your Answer:
Correct Answer: Lazarus theory
Explanation:The correct answer is the Lazarus theory, which proposes that emotions are the result of cognitive appraisal of a situation. According to this theory, the thought I’m being burgled triggers a cognitive appraisal of the situation, which in turn leads to the emotional response of fear. This is in contrast to the Singer-Schachter theory, which suggests that emotions are the result of a combination of physiological arousal and cognitive interpretation of that arousal.
Theories of Emotion
In membership exams, four main theories of emotion are commonly discussed: James-Lange theory, Cannon-Bard theory, Singer-Schachter theory, and Lazarus theory. The key to understanding the differences between these theories is to identify where the stimulus for the emotion arises.
According to the James-Lange theory, emotions occur as a result of bodily sensations. For instance, if you see a big dog, your heart races, and you feel afraid. This theory proposes that certain external stimuli stimulate specific sensory organs, leading to a particular emotion. The sequence of events suggested by this theory is as follows: event – arousal – interpretation – emotion. In other words, the stimulus for emotion arises from physical sensations.
The Cannon-Bard theory, also known as the thalami theory, proposes that when an event occurs, one experiences an emotion at the same time as physiological changes. The stimulus for emotion arises simultaneously in the body and the mind.
The Singer-Schachter theory, also known as the two-factor theory, suggests that emotions result from both physiological changes and the context. For example, if your heart is racing, and you are about to have an exam, you label yourself as afraid. However, if your heart is racing, and you are about to kiss your partner, you label your emotional state as excited. The stimulus for emotion arises via a combination of physical sensations and the mind’s appraisal of them.
Finally, the Lazarus theory proposes that a thought is required before an emotion occurs. For instance, if you see a big dog, you think it is going to bite you, and you feel afraid. The stimulus for emotion arises from the mind.
In summary, these theories offer different perspectives on the relationship between physical sensations, cognitive processes, and emotions.
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This question is part of the following fields:
- Social Psychology
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Question 69
Incorrect
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What is a characteristic physical trait of individuals with bulimia nervosa?
Your Answer:
Correct Answer: Bilateral parotid gland swelling
Explanation:Bulimia nervosa is a condition characterized by recurrent episodes of binge eating followed by compensatory behaviors such as vomiting, laxative use, of excessive exercise. One of the hallmark physical symptoms of bulimia nervosa is bilateral swelling of the parotid glands, which are located on either side of the face near the ears. This swelling is caused by repeated vomiting and can be a visible sign of the disorder. Other symptoms of bulimia nervosa may include dental problems, gastrointestinal issues, and electrolyte imbalances. The International Classification of Diseases, 10th Revision (ICD-10) classifies bulimia nervosa as F50.2.
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This question is part of the following fields:
- History And Mental State
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Question 70
Incorrect
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The nomenclature of PrPSc, the disease-linked form of mammalian prion protein PrP, was derived from a long-observed prion disease in which animal?
Your Answer:
Correct Answer: Sheep
Explanation:The term PrPSc originated from scrapie, a prion disease that affects sheep. In humans, the normal isoform of prion protein is PrPC, while the abnormal form is known as PrPres (protease-resistant) of PrPSc. Scrapie has been observed in sheep for over 300 years, while BSE in cattle was only identified in the 1980s. Feline spongiform encephalopathy (FSE) is a prion disease that affects cats, and Chronic wasting disease (CWD) is a similar condition that affects deer.
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This question is part of the following fields:
- Neurosciences
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Question 71
Incorrect
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Which schedule of reinforcement is the most difficult to extinguish?
Your Answer:
Correct Answer: Variable ratio
Explanation:Operant Conditioning: Reinforcement, Punishment, and More
Operant conditioning, also known as instrumental learning, is a theory of learning developed by B.F. Skinner. It suggests that people learn by interacting with their environment. Reinforcement and punishment are key concepts in operant conditioning. A reinforcer is a stimulus of event that increases the likelihood of a behavior being repeated. Reinforcement can be positive of negative. Positive reinforcement occurs when a behavior is strengthened by adding a rewarding stimulus, while negative reinforcement occurs when a behavior is strengthened by removing an unpleasant stimulus. A punisher is a stimulus that decreases the likelihood of a behavior being repeated. Positive punishment occurs when a behavior is reduced in frequency by adding an unpleasant stimulus, while negative punishment occurs when a behavior is reduced in frequency by removing a pleasant stimulus.
Primary reinforcers are instinctual desires such as food, water, social approval, and sex. Secondary reinforcers, also known as conditioned reinforcers, are not innately appreciated and people have to learn to like them through classical conditioning of other methods. Secondary reinforcers include things such as money. Different patterns of reinforcement have different influences on the response. There are five main reinforcement schedules: fixed interval, variable interval, fixed ratio, variable ratio, and random. Variable ratio schedules are most resistant to extinction.
Shaping and chaining are techniques used when an exact behavior cannot be performed and so cannot be rewarded. Shaping involves rewarding successive, increasingly accurate approximations to the behavior, while chaining involves breaking a complex task into smaller, more manageable sections. Escape conditioning refers to a situation whereby an aversive situation is removed after a response. It is a form of negative reinforcement. Habituation refers to the phenomenon whereby there is a decrease in response to a stimulus over time. Covert sensitization is a technique used whereby someone learns to use mental imagery to associate a behavior with a negative consequence.
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This question is part of the following fields:
- Social Psychology
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Question 72
Incorrect
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Which of the following is the least likely to cause discontinuation symptoms?
Your Answer:
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).
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This question is part of the following fields:
- Psychopharmacology
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Question 73
Incorrect
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Which artery blockage is most likely to cause Broca's aphasia?
Your Answer:
Correct Answer: Middle cerebral
Explanation:Brain Blood Supply and Consequences of Occlusion
The brain receives blood supply from the internal carotid and vertebral arteries, which form the circle of Willis. The circle of Willis acts as a shunt system in case of vessel damage. The three main vessels arising from the circle are the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). Occlusion of these vessels can result in various neurological deficits. ACA occlusion may cause hemiparesis of the contralateral foot and leg, sensory loss, and frontal signs. MCA occlusion is the most common and can lead to hemiparesis, dysphasia/aphasia, neglect, and visual field defects. PCA occlusion may cause alexia, loss of sensation, hemianopia, prosopagnosia, and cranial nerve defects. It is important to recognize these consequences to provide appropriate treatment.
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This question is part of the following fields:
- Neurosciences
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Question 74
Incorrect
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You are requested to evaluate a patient in the evening who has schizoaffective disorder, depressive subtype. They are currently taking oxazepam for night sedation, citalopram and haloperidol. They typically experience low energy levels and mild anxiety. Their psychotic symptoms of paranoid delusions have been improving. Yesterday, the dosage of each medication was increased. Today, they have become agitated, restless, and have assaulted another patient. You are contacted for assistance. Their blood pressure is 160/80 mmHg, pulse is 96 beats per minute, and temperature is 37.4°C. These measurements have been consistent for the past hour. They are alert and oriented, but visibly distressed. Their skin is dry, and their tone, reflexes, and level of consciousness are all normal. Their speech is normal in terms of rate and quantity. What is the most probable explanation for their change in behavior?
Your Answer:
Correct Answer: Akathisia
Explanation:When a patient experiences new onset agitation and restlessness, it can be caused by various factors such as exacerbation of their underlying condition, akathisia, serotonin syndrome, neuroleptic malignant syndrome, of confusional states due to drug-induced hyponatremia. It is crucial to conduct a thorough assessment to rule out the most severe causes. Akathisia is a type of extrapyramidal symptom that involves increased motor activity and a distressing feeling of restlessness. It is typically caused by antipsychotics, but SSRIs can also produce similar symptoms. Akathisia may increase the risk of aggression and suicide. Oxazepam, a short-acting benzodiazepine, is only prescribed at night and would have worn off by the time the patient was evaluated. Serotonin syndrome is a medical emergency caused by serotonergic medication and presents with symptoms such as sweating, confusion, increased reflexes, and myoclonus. Although it remains a possibility in an agitated patient with recent changes in serotonergic drugs, these symptoms were absent. Neuroleptic malignant syndrome is a medical emergency caused by dopamine antagonists and presents with symptoms such as fever, increased muscle tone, sweating, fluctuating consciousness, and fluctuating blood pressure. These symptoms were not present in this patient. While antidepressant-induced hypomania/mania is rare, this patient did not exhibit an increased rate of speech of any other symptoms of mania except for over-activity.
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This question is part of the following fields:
- Psychopharmacology
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Question 75
Incorrect
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What is the primary component of Hirano bodies?
Your Answer:
Correct Answer: Actin
Explanation:Actin is the primary component of Hirano bodies, which are indicative of neurodegeneration but lack specificity.
Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.
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This question is part of the following fields:
- Neurosciences
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Question 76
Incorrect
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A 70-year-old woman is undergoing a medical procedure and is unable to verbally communicate. The nurse provides her with a pen and paper to express any concerns of questions she may have about the procedure.
What principle of the Mental Capacity Act 2005 is the nurse attempting to uphold?Your Answer:
Correct Answer: A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
Explanation:In accordance with the Mental Capacity Act 2005, it is important to recognize that a person should not be considered lacking capacity unless all possible measures have been taken to assist them. The Act also establishes several principles, including the assumption that a person has capacity unless proven otherwise, and that a person should not be deemed incapable of making decisions without adequate support. Additionally, making an unwise decision does not necessarily indicate a lack of capacity. Any actions of decisions made on behalf of a person lacking capacity must be made in their best interests, and consideration should be given to whether there are less restrictive options available.
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This question is part of the following fields:
- Basic Ethics And Philosophy Of Psychiatry
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Question 77
Incorrect
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Which of the options below does not diminish the effectiveness of the oral contraceptive pill when used together?
Your Answer:
Correct Answer: Sodium valproate
Explanation:It is safe to use sodium valproate together with the oral contraceptive pill. However, as valproate is known to cause birth defects, all women who use it and are of childbearing age must also use contraception.
Interactions with Oral Contraceptives
Psychiatric drugs such as St John’s Wort, Carbamazepine, Phenytoin, Topiramate, and Barbiturates can interact with oral contraceptives and lead to a reduced contraceptive effect. It is important to be aware of these potential interactions to ensure the effectiveness of oral contraceptives.
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This question is part of the following fields:
- Psychopharmacology
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Question 78
Incorrect
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What is a true statement about antihistamines?
Your Answer:
Correct Answer: First generation antihistamines should be avoided in people at risk of angle closure glaucoma
Explanation:First generation antihistamines should be avoided in individuals who are at risk of angle closure glaucoma due to their tendency to cause anticholinergic side effects. Pupil dilation (mydriasis) caused by these medications can increase the risk of angle closure glaucoma in individuals with narrow anterior chamber angles, but this is not a concern for those with open angle glaucoma.
Antihistamines: Types and Uses
Antihistamines are drugs that block the effects of histamine, a neurotransmitter that regulates physiological function in the gut and potentiates the inflammatory and immune responses of the body. There are two types of antihistamines: H1 receptor blockers and H2 receptor blockers. H1 blockers are mainly used for allergic conditions and sedation, while H2 blockers are used for excess stomach acid.
There are also first and second generation antihistamines. First generation antihistamines, such as diphenhydramine and promethazine, have uses in psychiatry due to their ability to cross the blood brain barrier and their anticholinergic properties. They tend to be sedating and are useful for managing extrapyramidal side effects. Second generation antihistamines, such as loratadine and cetirizine, show limited penetration of the blood brain barrier and are less sedating.
It is important to note that there are contraindications to first-generation antihistamines, including benign prostatic hyperplasia, angle-closure glaucoma, and pyloric stenosis in infants. These do not apply to second-generation antihistamines.
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This question is part of the following fields:
- Psychopharmacology
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Question 79
Incorrect
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Which drug experiences the most substantial first-pass metabolism?
Your Answer:
Correct Answer: Imipramine
Explanation:The First Pass Effect in Psychiatric Drugs
The first-pass effect is a process in drug metabolism that significantly reduces the concentration of a drug before it reaches the systemic circulation. This phenomenon is related to the liver and gut wall, which absorb and metabolize the drug before it can enter the bloodstream. Psychiatric drugs are not exempt from this effect, and some undergo a significant reduction in concentration before reaching their target site. Examples of psychiatric drugs that undergo a significant first-pass effect include imipramine, fluphenazine, morphine, diazepam, and buprenorphine. On the other hand, some drugs undergo little to no first-pass effect, such as lithium and pregabalin.
Orally administered drugs are the most affected by the first-pass effect. However, there are other routes of administration that can avoid of partly avoid this effect. These include sublingual, rectal (partly avoids first pass), intravenous, intramuscular, transdermal, and inhalation. Understanding the first-pass effect is crucial in drug development and administration, especially in psychiatric drugs, where the concentration of the drug can significantly affect its efficacy and safety.
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This question is part of the following fields:
- Psychopharmacology
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Question 80
Incorrect
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A 45-year-old woman accompanied by her husband was seen by her GP. Over several months she had begun to hear voices. These voices could be heard at any time. Sometimes the voices would demand her to do things; sometimes they would hum of laugh. Over the months she had developed the notion that her husband was having an affair and was planning to leave her. In addition, she believed that she had a deadly illness and was unlikely to live for more than a year.
The arguments that followed these 'ideas' had caused a huge rift between her and her husband, as he had been unable to convince her that they were not true. She had lost over a stone in weight, had become increasingly nervous and was neglecting her appearance. She had no known medical problems and was not taking any regular medication. She was a smoker of 10 cigarettes per day and drank 10 units of alcohol per week. She worked as a teacher, but had recently taken time off sick. She had a brother with schizophrenia, but there were no other known family illnesses.
On examination, she appeared withdrawn and unkempt. She continued to fidget with her clothes and continually commented she could smell smoke. She was able to talk fluently about her childhood and university years which appeared to be happy times. The death of her father three years ago had been 'difficult'. She scored 28/30 on mini-mental state examination. Cranial nerve and peripheral nervous system examination did not reveal any abnormalities. An MRI scan of her brain was normal.
What is the most likely diagnosis in this patient?Your Answer:
Correct Answer: Paranoid schizophrenia
Explanation:Paranoid Schizophrenia Diagnosis
This patient’s symptoms include hearing hallucinatory voices that command him to do things of non-verbal forms such as humming of laughing. He also experiences delusions with a persecutory of jealousy theme, as well as hallucinations of smell, changes in weight, and neglect of personal hygiene. These symptoms are consistent with a diagnosis of paranoid schizophrenia.
The patient’s clinical picture is dominated by fixed delusions, with less emphasis on mood changes, making diagnoses of psychotic depression and bipolar disease less likely. There is no evidence of epileptic-form activity of altered awareness during episodes of delusions or hallucinations.
It is important to differentiate paranoid schizophrenia from other disorders, such as schizoid personality disorder, which is characterized by emotional coldness, detachment, limited capacity to express emotion, and subsequently, few friends of close relationships.
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This question is part of the following fields:
- Diagnosis
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Question 81
Incorrect
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What signs of symptoms are indicative of Fragile X syndrome?
Your Answer:
Correct Answer: Elongated face
Explanation:Fragile X Syndrome: A Genetic Disorder Causing Learning Disability and Psychiatric Symptoms
Fragile X Syndrome is a genetic disorder that causes mental retardation, an elongated face, large protruding ears, and large testicles in men. Individuals with this syndrome tend to be shy, avoid eye contact, and have difficulties reading facial expressions. They also display stereotypic movements such as hand flapping. Fragile X Syndrome is the most common inherited cause of learning disability.
The speech of affected individuals is often abnormal, with abnormalities of fluency. This disorder is caused by the amplification of a CGG repeat in the 5 untranslated region of the fragile X mental retardation 1 gene (FMR1). These CGG repeats disrupt synthesis of the fragile X protein (FMRP), which is essential for brain function and growth. The gene is located at Xq27. The greater number of repeats, the more severe the condition, as with other trinucleotide repeat disorders.
The fragile X phenotype typically involves a variety of psychiatric symptoms, including features of autism, attention deficit/hyperactivity disorder, anxiety, and aggression. Both males and females can be affected, but males are more severely affected because they have only one X chromosome. The prevalence estimate of Fragile X Syndrome is 1/3600-4000.
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This question is part of the following fields:
- Genetics
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Question 82
Incorrect
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What is the most frequently occurring genetic mutation in individuals with early onset familial Alzheimer's disease?
Your Answer:
Correct Answer: PSEN1
Explanation:Genetics plays a role in the development of Alzheimer’s disease, with different genes being associated with early onset and late onset cases. Early onset Alzheimer’s, which is rare, is linked to three genes: amyloid precursor protein (APP), presenilin one (PSEN-1), and presenilin two (PSEN-2). The APP gene, located on chromosome 21, produces a protein that is a precursor to amyloid. The presenilins are enzymes that cleave APP to produce amyloid beta fragments, and alterations in the ratios of these fragments can lead to plaque formation. Late onset Alzheimer’s is associated with the apolipoprotein E (APOE) gene on chromosome 19, with the E4 variant increasing the risk of developing the disease. People with Down’s syndrome are also at high risk of developing Alzheimer’s due to inheriting an extra copy of the APP gene.
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This question is part of the following fields:
- Genetics
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Question 83
Incorrect
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What type of speech disorder is commonly associated with spasticity and would be most likely to be observed in a patient?
Your Answer:
Correct Answer: Pseudobulbar palsy
Explanation:Dysarthria is a speech disorder that affects the volume, rate, tone, of quality of spoken language. There are different types of dysarthria, each with its own set of features, associated conditions, and localisation. The types of dysarthria include spastic, flaccid, hypokinetic, hyperkinetic, and ataxic.
Spastic dysarthria is characterised by explosive and forceful speech at a slow rate and is associated with conditions such as pseudobulbar palsy and spastic hemiplegia.
Flaccid dysarthria, on the other hand, is characterised by a breathy, nasal voice and imprecise consonants and is associated with conditions such as myasthenia gravis.
Hypokinetic dysarthria is characterised by slow, quiet speech with a tremor and is associated with conditions such as Parkinson’s disease.
Hyperkinetic dysarthria is characterised by a variable rate, inappropriate stoppages, and a strained quality and is associated with conditions such as Huntington’s disease, Sydenham’s chorea, and tardive dyskinesia.
Finally, ataxic dysarthria is characterised by rapid, monopitched, and slurred speech and is associated with conditions such as Friedreich’s ataxia and alcohol abuse. The localisation of each type of dysarthria varies, with spastic and flaccid dysarthria affecting the upper and lower motor neurons, respectively, and hypokinetic, hyperkinetic, and ataxic dysarthria affecting the extrapyramidal and cerebellar regions of the brain.
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This question is part of the following fields:
- Neurosciences
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Question 84
Incorrect
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What factor is most likely to increase the levels of clozapine in the bloodstream?
Your Answer:
Correct Answer: Caffeine
Explanation:CYP1A2 is responsible for metabolizing caffeine, and it competes with other drugs that are also metabolized by this enzyme. When caffeine is consumed excessively, it can deplete the CYP1A2, leaving none available to metabolize clozapine, resulting in increased levels of clozapine. However, this is not a common issue in clinical settings.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 85
Incorrect
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What substance acts on the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system to produce its effects?
Your Answer:
Correct Answer: Pregabalin
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 86
Incorrect
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Which category does utilitarianism belong to?
Your Answer:
Correct Answer: Teleology
Explanation:Teleology, derived from the Greek words for goal and theory, is a moral philosophy that emphasizes the outcomes of actions as the initial consideration in evaluating ethical behavior. This category of theories is also known as consequentialism, as it focuses on the consequences of an action as the basis for determining its morality. Consequentialism evaluates the morality of an action based on the balance of its positive and negative outcomes. Utilitarianism of social consequentialism is the most prevalent form of consequentialism, although it is not the only one.
Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.
More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.
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This question is part of the following fields:
- Social Psychology
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Question 87
Incorrect
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For a 45-year-old man who has not seen improvement with two different antidepressants, what combination of medications would you recommend?
Your Answer:
Correct Answer: Mirtazapine and sertraline
Explanation:The cautious use of combined antidepressants can be considered for depression management, taking into account their mechanism of action. NICE suggests the combination of mirtazapine and SSRI for treatment-resistant depression. However, other combinations should be avoided due to the risk of interaction.
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This question is part of the following fields:
- Psychopharmacology
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Question 88
Incorrect
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What are some common symptoms that are typically observed in the initial phases of Alzheimer's disease?
Your Answer:
Correct Answer: Hippocampal atrophy
Explanation:The medial temporal lobe, comprising the hippocampus and parahippocampal gyrus, exhibits the earliest neuropathological alterations.
Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.
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This question is part of the following fields:
- Neurosciences
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Question 89
Incorrect
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A 70-year-old individual presents with a fluent dysphasia and inability to understand instructions. What is the probable location of arterial blockage?
Your Answer:
Correct Answer: Inferior division of middle cerebral artery (dominant hemisphere)
Explanation:Wernicke’s aphasia is caused by a blockage in the inferior division of the middle cerebral artery, which provides blood to the temporal cortex (specifically, the posterior superior temporal gyrus of ‘Wernicke’s area’). This type of aphasia is characterized by fluent speech, but with significant comprehension difficulties. On the other hand, Broca’s aphasia is considered a non-fluent expressive aphasia, resulting from damage to Brodmann’s area in the frontal lobe.
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This question is part of the following fields:
- Neurosciences
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Question 90
Incorrect
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What was the outcome of the war crimes tribunals that dealt with human experimentation at the conclusion of World War II?
Your Answer:
Correct Answer: Nuremberg Code
Explanation:The Nuremberg Code is a set of ethical principles for human experimentation that emerged from the Nuremberg trials after World War II. It includes guidelines such as obtaining informed consent, avoiding harm to participants, and not conducting experiments that may result in death.
The Helsinki Declaration, established by the World Medical Association, is another set of ethical principles for human research. It has been amended several times since its adoption in 1964 and provides guidelines for conducting research with human subjects.
The Declaration of Geneva is a statement of a physician’s commitment to the humanitarian goals of medicine. It was created as a revision of the Hippocratic oath and has been amended and revised over time.
The Nightingale Pledge is a statement of ethical principles for the nursing profession. It outlines the responsibilities and commitments of nurses to their patients and the healthcare system.
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This question is part of the following fields:
- Basic Ethics And Philosophy Of Psychiatry
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Question 91
Incorrect
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What is a true statement about the Glasgow Coma Scale?
Your Answer:
Correct Answer: A score of 2 out of 4 is given to patient who opens their eyes to pain
Explanation:The assessment of intersecting pentagons is included in the mini mental state exam, while the Glasgow Coma Scale (GCS) is primarily utilized to evaluate impaired consciousness resulting from factors like trauma and substance abuse.
The Glasgow Coma Scale is used to assess the depth of coma and impaired consciousness. Scores range from 3 to 15, with impaired consciousness rated as mild, moderate, of severe. The scale assesses eye opening response, verbal response, and motor response, with specific criteria for scoring each behavior. The final score is a combination of these three scores.
Scoring Guide;
Eye opening response
4 Spontaneous opening
3 Opens to verbal stimuli
2 Opens to pain
1 No response
Verbal response
5 Orientated
4 Confused conversation
3 Inappropriate words
2 Incoherent
1 No response
Motor response
6 Obeys commands
5 Purposeful movement to painful stimuli
4 Withdraws in response to pain
3 Flexion in response to pain (decorticate posturing)
2 Extension in response to pain (decerebrate posturing)
1 No response -
This question is part of the following fields:
- Classification And Assessment
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Question 92
Incorrect
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What does the Flynn Effect refer to in terms of changes observed in successive generations?
Your Answer:
Correct Answer: Intelligence
Explanation:The Flynn Effect is the term used to describe the increase in standardised intelligence test scores over time. Research conducted by Flynn showed that IQ scores increased by 13.8 points between 1932 and 1978, which equates to a 0.3-point increase per year of approximately 3 points per decade. More recent studies have also supported the Flynn effect, with IQ score gains observed between 1972 and 2006. This means that an individual is likely to achieve a higher IQ score on an earlier version of a test than on the current version. In fact, the test will overestimate an individual’s IQ score by an average of 0.3 points per year between the year in which the test was normed and the year in which the test was administered.
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This question is part of the following fields:
- Classification And Assessment
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Question 93
Incorrect
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What is a true statement about the cytochrome P450 system?
Your Answer:
Correct Answer: CYP2D6 shows the largest phenotypic variation amongst the cytochromes
Explanation:The liver plays a significant role in breaking down clozapine through the action of CYP450 enzymes, with CYP1A2, CYP3A4, and CYP2D6 being particularly involved in the process.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 94
Incorrect
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A patient complains that his deceased grandfather is putting thoughts into his head. This type of thought disorder is referred to as:
Your Answer:
Correct Answer: Passivity
Explanation:Patients may feel that they have lost control over their thoughts, which can manifest as passivity of thought. This refers to the belief that an external agency is controlling one’s thoughts. Passivity can take different forms, such as thought withdrawal, thought insertion, and thought broadcasting.
Ego (Boundary) Disturbances
Ego (boundary) disturbances refer to experiences where there is a disturbance in the perception of self as distinct from the environment of the integrity of self. It also includes instances where bodily processes, personal thought processes, feelings, and actions are experienced as being externally directed. These phenomena are referred to as passivity phenomena, and some of the symptom characteristics are classified as bizarre delusional phenomena in the DSM.
Derealization is when a patient experiences their surroundings of time as if they are unreal and changed, losing all feelings of familiarity and trust in the environment. People, objects, and surroundings appear unreal, unfamiliar, of spatially altered. The sensations may be intense of weak in nature.
Depersonalization is when a patient perceives themselves as alien, unreal, changed, of as a stranger. The disturbances of depersonalization may be of a transient nature only of become more persistent over a longer period of time. It is generally felt to be both strange and unpleasant.
Thought broadcasting is when a patient’s personal thoughts are experienced as no longer belonging to the patient alone but accessible by others who will know what the patient is thinking (mind reading). Thought withdrawal is when a patient’s thoughts are being removed of stripped from them. Thought insertion is when patients experience their thoughts and ideas as being externally influenced, made externally, controlled, directed, entered/ of externally imposed.
Other feelings of alien influence refer to feelings, intentions, behavior, of bodily functions that are experienced as externally controlled of made by others (passivity phenomena). The patient feels externally compelled to say something specific, to scream, to act of behave in a particular way, to attack someone, to throw a tantrum, etc.
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This question is part of the following fields:
- Classification And Assessment
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Question 95
Incorrect
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Which disorder is more frequently identified in individuals from higher socioeconomic backgrounds?
Your Answer:
Correct Answer: Bipolar affective disorder
Explanation:Individuals from higher social classes are more likely to be diagnosed with bipolar affective disorder and eating disorders, while those from lower social classes are more commonly diagnosed with alcohol dependence, depression, schizophrenia, and substance misuse disorders.
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This question is part of the following fields:
- Epidemiology
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Question 96
Incorrect
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A 55-year-old man complains of frequent nighttime urination.
He has been taking lithium for his bipolar disorder for more than a decade without any notable adverse effects. His eGFR is 38 mls/min and his serum creatinine is slightly elevated.
What is the most probable diagnosis?Your Answer:
Correct Answer: Nephrogenic diabetes insipidus
Explanation:Nocturia is often the first indication of nephrogenic diabetes insipidus, which can occur in 20-40% of patients who take lithium for an extended period. This condition can cause a gradual decrease in the GFR, which may be reversible in the early stages. If muscle mass is reduced of the diet is low in protein, the serum creatinine level may be normal of near-normal.
Hyperparathyroidism is not a likely cause because although 15-20% of long-term lithium users may have elevated calcium levels, only a few will experience hyperparathyroidism symptoms.
Syndrome of inappropriate ADH secretion is not associated with lithium therapy and would not present with polyuria of renal impairment.
Tubulointerstitial nephritis is a rare complication of lithium therapy.
Water intoxication would cause polyuria of dilutional hyponatremia, but not renal impairment.
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This question is part of the following fields:
- Psychopharmacology
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Question 97
Incorrect
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Which of the following is the least probable cause of electroencephalographic alterations?
Your Answer:
Correct Answer: Quetiapine
Explanation:Antipsychotics and Their Effects on EEG
The use of antipsychotics has been found to have an impact on the EEG of patients taking them. A study conducted on the subject found that clozapine had the highest percentage of EEG changes at 47.1%, followed by olanzapine at 38.5%, risperidone at 28.0%, and typical antipsychotics at 14.5%. Interestingly, quetiapine did not show any EEG changes in the study. However, another study found that 5% of quetiapine users did experience EEG changes. These findings suggest that antipsychotics can have varying effects on EEG and should be monitored closely in patients taking them.
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This question is part of the following fields:
- Psychopharmacology
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Question 98
Incorrect
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What is the most sleep-inducing SSRI for older adults?
Your Answer:
Correct Answer: Paroxetine
Explanation:Compared to other SSRIs, paroxetine has a higher affinity for muscarinic acetylcholine receptors, resulting in greater sedation. Conversely, citalopram and escitalopram have a low likelihood of causing sedation. Fluoxetine and sertraline do not typically induce sedation.
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This question is part of the following fields:
- Psychopharmacology
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Question 99
Incorrect
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Where are Lewy bodies commonly located within the basal ganglia in individuals with Parkinson's disease?
Your Answer:
Correct Answer: The pars compacta
Explanation:The midbrain contains a section called the pars compacta, which is made up of neurons that produce dopamine and is situated next to the pars reticulata. Parkinson’s disease is identified by the loss of these dopamine-producing neurons in this area.
Parkinson’s Disease Pathology
Parkinson’s disease is a neurodegenerative disorder that affects the central nervous system. The pathology of Parkinson’s disease is very similar to that of Lewy body dementia. The macroscopic features of Parkinson’s disease include pallor of the substantia nigra (midbrain) and locus coeruleus (pons). The microscopic changes include the presence of Lewy bodies, which are intracellular aggregates of alpha-synuclein. Additionally, there is a loss of dopaminergic cells from the substantia nigra pars compacta. These changes contribute to the motor symptoms of Parkinson’s disease, such as tremors, rigidity, and bradykinesia. Understanding the pathology of Parkinson’s disease is crucial for developing effective treatments and improving the quality of life for those affected by this condition.
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This question is part of the following fields:
- Neurosciences
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Question 100
Incorrect
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A student's parent complains about a teacher who they claim was too honest with their child which caused them to become upset. The student had asked the teacher if they were doing well in the class to which the teacher replied that they were struggling and needed to improve their grades.
In supervision with the principal, the teacher explained that they chose to be honest as they believe honesty is the best policy. They said they base this decision on the fact that if they were to lie, the student would not improve and would continue to struggle. They confirmed that they were aware that the student's response would be to become upset.
Which of the following ethical approaches is most aligned to the teacher's decision making?Your Answer:
Correct Answer: Deontological
Explanation:The doctor’s decision is grounded in the moral righteousness of the act, rather than its consequences, and is therefore based on the principles of deontology, specifically the ‘categorical imperative’.
Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.
More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.
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This question is part of the following fields:
- Social Psychology
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