-
Question 1
Incorrect
-
For male patients with learning disabilities who have newly diagnosed generalised tonic-clonic epilepsy, NICE recommends which of the following as the first-line treatment?
Your Answer: Levetiracetam
Correct Answer: Sodium valproate
Explanation:If the question had been about a female patient with learning difficulties, the pharmacological management of epilepsy may need to be adjusted based on factors such as hormonal changes and potential interactions with birth control medication.
Epilepsy: An Overview
Epilepsy is a condition that is diagnosed when a person experiences at least two unprovoked seizures that occur more than 24 hours apart. In the UK, the prevalence of epilepsy is 5-10 cases per 1000. Seizure types are categorized as focal onset of generalized onset. Focal seizures only involve a localized part of the brain, while generalized seizures involve the whole of both hemispheres. Temporal lobe epilepsy is the most common type of focal epilepsy, accounting for 60-70% of cases.
In 60% of people with epilepsy, there is no identifiable cause. Approximately 70% of people with epilepsy achieve remission, meaning they have no seizures for 5 years on of off treatment. of those with convulsive seizures, 2/3 have focal epilepsies and secondary generalized seizures, while the other 1/3 have generalized tonic-clonic seizures.
The National Institute for Health and Care Excellence (NICE) recommends treatment with antiepileptic drugs (AEDs) after a second epileptic seizure. For newly diagnosed focal seizures, carbamazepine of lamotrigine are recommended as first-line treatment. Levetiracetam, oxcarbazepine, of sodium valproate may be offered if carbamazepine and lamotrigine are unsuitable of not tolerated. For newly diagnosed generalized tonic-clonic seizures, sodium valproate is recommended as first-line treatment, with lamotrigine as an alternative if sodium valproate is unsuitable. For absence seizures, ethosuximide of sodium valproate are recommended as first-line treatment. For myoclonic seizures, sodium valproate is recommended as first-line treatment, and for tonic of atonic seizures, sodium valproate is also recommended as first-line treatment.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 2
Incorrect
-
Which of the following pairs is correctly matched?
Your Answer: Thienobenzodiazepine - Aripiprazole
Correct Answer: Butyrophenone - Haloperidol
Explanation:Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 3
Incorrect
-
What should be avoided in individuals with hepatic impairment?
Your Answer: Mirtazapine
Correct Answer: Duloxetine
Explanation:Duloxetine undergoes hepatic metabolism and its clearance is significantly decreased even in cases of mild impairment. There have been documented cases of hepatocellular injury and, although rare, jaundice. A single case of fulminant hepatic failure has also been reported. Therefore, individuals with hepatic impairment should not take duloxetine as it is contraindicated (as stated in the Maudsley 14th Ed).
Hepatic Impairment: Recommended Drugs
Patients with hepatic impairment may experience reduced ability to metabolize drugs, toxicity, enhanced dose-related side effects, reduced ability to synthesize plasma proteins, and elevated levels of drugs subject to first-pass metabolism due to reduced hepatic blood flow. The Maudsley Guidelines 14th Ed recommends the following drugs for patients with hepatic impairment:
Antipsychotics: Paliperidone (if depot required), Amisulpride, Sulpiride
Antidepressants: Sertraline, Citalopram, Paroxetine, Vortioxetine (avoid TCA and MAOI)
Mood stabilizers: Lithium
Sedatives: Lorazepam, Oxazepam, Temazepam, Zopiclone 3.75mg (with care)
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 4
Incorrect
-
A score of 9-12 on the Glasgow Coma Scale signifies what?
Your Answer: Mildly impaired consciousness
Correct Answer: Moderately impaired consciousness
Explanation: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
-
-
Question 5
Incorrect
-
If two adults with an autosomal recessive condition have a child, what is the likelihood that the child will also have of develop the condition?
Your Answer: 25%
Correct Answer: 100%
Explanation:Mendelian Inheritance (Pedigrees)
Mendelian inheritance refers to the transmission patterns of genetic conditions caused by a mutation in a single gene. There are four types of Mendelian inheritance patterns: autosomal dominant, autosomal recessive, X-linked recessive, and X-linked dominant. Each pattern follows a predictable inheritance pattern within families.
Autosomal dominant conditions are expressed in individuals who have just one copy of the mutant allele. Affected males and females have an equal probability of passing on the trait to offspring. In contrast, autosomal recessive conditions are clinically manifest only when an individual has two copies of the mutant allele. X-linked recessive traits are fully evident in males because they only have one copy of the X chromosome, while women are rarely affected by X-linked recessive diseases. X-linked dominant disorders are clinically manifest when only one copy of the mutant allele is present.
Common examples of conditions with specific inheritance patterns include neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, Noonan’s syndrome for autosomal dominant; phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, cystic fibrosis for autosomal recessive; vitamin D resistant rickets, Rett syndrome for X-linked dominant; and cerebellar ataxia, Hunter’s syndrome, Lesch-Nyhan for X-linked recessive.
-
This question is part of the following fields:
- Genetics
-
-
Question 6
Incorrect
-
Among the given chromosomal abnormalities, which one is commonly linked to aggressive behavior?
Your Answer: 47 XXY
Correct Answer: 47 XYY
Explanation:While XYY has been proposed as a potential contributor to aggressive behavior, it is more likely that the observed increase in aggression among individuals with this genetic makeup is a result of other factors such as low IQ and social deprivation, which are more prevalent in the XYY population. Therefore, XYY is not considered to be the sole cause of aggressiveness.
XYY Syndrome
XYY Syndrome, also known as Jacobs’ Syndrome of super-males, is a genetic condition where males have an extra Y chromosome, resulting in a 47, XYY karyotype. In some cases, mosaicism may occur, resulting in a 47,XYY/46,XY karyotype. The error leading to the 47,XYY genotype occurs during spermatogenesis of post-zygotic mitosis. The prevalence of XYY Syndrome is as high as 1:1000 male live births, but many cases go unidentified as they are not necessarily associated with physical of cognitive impairments. The most common features are high stature and a strong build, and fertility and sexual development are usually unaffected. In the past, XYY Syndrome was linked to aggressiveness and deviance, but this is likely due to intermediate factors such as reduced IQ and social deprivation. XYY Syndrome is best thought of as a risk factor rather than a cause. There is an increased risk of developmental disorders such as learning difficulties, ASD, ADHD, and emotional problems.
-
This question is part of the following fields:
- Genetics
-
-
Question 7
Correct
-
What is a significant byproduct of clozapine metabolism?
Your Answer: N-desmethylclozapine
Explanation:Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 8
Incorrect
-
An elderly woman attempts to light herself on fire to demonstrate to her therapist that she has already passed away. What type of delusion is this an example of?
Your Answer: Delusional infestation
Correct Answer: Cotard's syndrome
Explanation:Types of Delusions
Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:
– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 9
Correct
-
In which part of the skull is the structure located in the posterior cranial fossa?
Your Answer: Foramen magnum
Explanation:The base of the skull contains a sizable opening called the foramen magnum, which permits the spinal cord to pass through.
Cranial Fossae and Foramina
The cranium is divided into three regions known as fossae, each housing different cranial lobes. The anterior cranial fossa contains the frontal lobes and includes the frontal and ethmoid bones, as well as the lesser wing of the sphenoid. The middle cranial fossa contains the temporal lobes and includes the greater wing of the sphenoid, sella turcica, and most of the temporal bones. The posterior cranial fossa contains the occipital lobes, cerebellum, and medulla and includes the occipital bone.
There are several foramina in the skull that allow for the passage of various structures. The most important foramina likely to appear in exams are listed below:
– Foramen spinosum: located in the middle fossa and allows for the passage of the middle meningeal artery.
– Foramen ovale: located in the middle fossa and allows for the passage of the mandibular division of the trigeminal nerve.
– Foramen lacerum: located in the middle fossa and allows for the passage of the small meningeal branches of the ascending pharyngeal artery and emissary veins from the cavernous sinus.
– Foramen magnum: located in the posterior fossa and allows for the passage of the spinal cord.
– Jugular foramen: located in the posterior fossa and allows for the passage of cranial nerves IX, X, and XI.Understanding the location and function of these foramina is essential for medical professionals, as they play a crucial role in the diagnosis and treatment of various neurological conditions.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 10
Incorrect
-
Which of the following best describes a scenario where a patient vividly remembers their activities during the 9/11 attacks while attending an outpatient appointment?
Your Answer: Semantic memory
Correct Answer: Flashbulb memory
Explanation:Flashbulb Memory
Flashbulb memories are vivid and detailed recollections of the circumstances surrounding a significant event. These memories are typically episodic, meaning they are focused on the specific details of the event rather than just the facts. One example of a flashbulb memory might be recalling where you were and what you were doing when you first heard about the death of Princess Diana in 1997. What sets flashbulb memories apart from other types of memories is the high level of emotional arousal that accompanies them. This emotional intensity helps to cement the memory in the mind, making it more vivid and long-lasting.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 11
Correct
-
Whilst assessing a woman with schizophrenia you notice she is vague and cannot recall basic details such as what she ate for breakfast of how she traveled to the appointment. She is accompanied by a carer who explains that the patient has not been the same since she had a head injury 8 months ago. The woman has a relatively good memory for aspects of her childhood such as where she was born and what school she attended. Which of the following is suggested?
Your Answer: Anterograde amnesia
Explanation:The head injury resulted in anterograde amnesia, which is characterized by memory loss for events that occurred after the injury.
Understanding Amnesia: Types and Causes
Amnesia is a memory deficit that can be categorized into two types: anterograde and retrograde. Anterograde amnesia refers to the inability to create new memories, while retrograde amnesia refers to the loss of memory for information acquired before the onset of amnesia. The damage to the hippocampus and medial temporal lobe is often associated with amnesia. Source amnesia is the inability to remember where of how previously learned information was acquired. Psychogenic amnesia is characterized by sudden retrograde episodic memory loss, while semantic amnesia affects semantic memory and language use. Transient global amnesia is a condition that affects those over 50 and spontaneously resolves within 24 hours, with no clear cause identified. Understanding the types and causes of amnesia can help in its diagnosis and treatment.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 12
Incorrect
-
Which statement accurately describes aneuploidy?
Your Answer: The most common sex chromosome aneuploidy is Turner's syndrome
Correct Answer: Most aneuploidies result from the nondisjunction of chromosomes during meiosis I
Explanation:Aneuploidy: Abnormal Chromosome Numbers
Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.
Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.
The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.
-
This question is part of the following fields:
- Genetics
-
-
Question 13
Correct
-
For a 45-year-old man who has not seen improvement with two different antidepressants, what combination of medications would you recommend?
Your 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.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 14
Correct
-
What is a true statement about lithium?
Your Answer: It exists in an unbound form in the blood
Explanation:Lithium has a tendency to remain unattached to proteins and instead remains unbound within the body, resulting in its efficient elimination from the bloodstream through haemodialysis.
Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
-
-
Question 15
Incorrect
-
A 45-year-old woman has been diagnosed with schizophrenia. What factor indicates a negative outcome?
Your Answer: Few of no episodes in the past
Correct Answer: Gradual onset
Explanation:A slow and steady development indicates a negative outcome, while all other factors suggest a positive prognosis.
-
This question is part of the following fields:
- Aetiology
-
-
Question 16
Incorrect
-
In which area of memory is a patient with dementia experiencing difficulty in recalling the specifics of their wedding?
Your Answer: Semantic
Correct Answer: Episodic
Explanation:Memory Forms
Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.
Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).
Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.
Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).
Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 17
Incorrect
-
What gene is thought to be abnormal in individuals diagnosed with tuberous sclerosis?
Your Answer: IT15
Correct Answer: TSC1
Explanation:Rett syndrome is caused by mutations in the MeCP2 gene.
Tuberous Sclerosis: A Neurocutaneous Syndrome with Psychiatric Comorbidity
Tuberous sclerosis is a genetic disorder that affects multiple organs, including the brain, and is associated with significant psychiatric comorbidity. This neurocutaneous syndrome is inherited in an autosomal dominant pattern with a high penetrance rate of 95%, but its expression can vary widely. The hallmark of this disorder is the growth of multiple non-cancerous tumors in vital organs, including the brain. These tumors result from mutations in one of two tumor suppressor genes, TSC1 and TSC2. The psychiatric comorbidities associated with tuberous sclerosis include autism, ADHD, depression, anxiety, and even psychosis.
-
This question is part of the following fields:
- Genetics
-
-
Question 18
Correct
-
What brain structures are responsible for regulating breathing and heart rate?
Your Answer: Medulla
Explanation:The medulla governs the rhythm of the heart and respiration. The amygdala regulates emotional reactions and the ability to perceive the emotions of others. The midbrain is linked to vision, hearing, motor coordination, sleep patterns, alertness, and temperature regulation. The cerebellum manages voluntary movement and balance. The thalamus transmits sensory and motor signals to the cerebral cortex.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 19
Incorrect
-
A middle-aged man with memory impairment is observed to wear his watch on his left wrist and then to put on another watch and wear it on his right wrist.
What phenomenon is being demonstrated in this scenario?Your Answer: Echopraxia
Correct Answer: Perseveration
Explanation:Common Behavioral Symptoms in Dementia
Perseveration is a behavior where a person repeatedly carries out an action beyond its normal usefulness. This behavior is often observed in individuals with dementia. Another behavior seen in dementia is Ambitendency, where a person alternates between two different actions. Echopraxia is an automatic imitation of the interviewer’s movement, even when asked not to. Mannerism is a repetitive action that appears to have some functional significance, such as saluting. Lastly, stereotypy is a repeated, regular movement that appears to have no significance. These behaviors can be challenging for caregivers to manage and may require specialized interventions.
-
This question is part of the following fields:
- Descriptive Psychopathology
-
-
Question 20
Correct
-
What is a true statement about migraines?
Your Answer: They can be precipitated by stress
Explanation:Migraine
Migraine is a common condition that affects 5-10% of the population, with a higher prevalence in women than men (2-3:1). It typically starts in childhood of adolescence and has a strong familial association, with 2/3 of cases reporting a family history of migraine.
The most prominent symptom of migraine is headache, which is usually unilateral but can occur on both sides. Other symptoms include anorexia, nausea and vomiting, photophobia, and intolerance of noise.
In about 1/3 of cases, migraines are preceded by a visual aura (known as classic migraine). The most common form of visual aura is the ‘fortification spectra’ (semicircle of zigzag lights), but other disturbances such as micropsia, macropsia, zoom vision, mosaic vision, scotomas, and even hallucinations can occur.
Basilar migraines are a subtype of migraine where headache and aura are accompanied by difficulty speaking, vertigo, ringing in ears, of other brainstem-related symptoms, but not motor weakness.
Migraine can be triggered by various factors, including alcohol, cheese, chocolate, skipping meals, missing sleep, and oral contraceptives. Stress is also a common precipitant of migraine.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 21
Incorrect
-
Which inheritance pattern is not consistent with Mendelian genetics?
Your Answer: Y-linked
Correct Answer: All are types of Mendelian inheritance
Explanation:The Law of Segregation and the Law of Independent Assortment are two fundamental principles of Mendelian inheritance. The Law of Segregation states that during gamete formation, the two alleles of a gene separate from each other so that each gamete receives only one allele. This means that offspring inherit one allele from each parent. The Law of Independent Assortment states that the inheritance of one gene does not affect the inheritance of another gene. This means that the alleles of different genes are distributed randomly into gametes. These laws are essential in understanding the inheritance patterns of single gene disorders. By following these laws, scientists can predict the likelihood of certain traits of disorders being passed down from one generation to the next.
-
This question is part of the following fields:
- Genetics
-
-
Question 22
Incorrect
-
Before being utilized for mood disorders, what medical conditions was lithium employed to treat?
Your Answer: Epilepsy
Correct Answer: Gout
Explanation:During the latter half of the 19th century, the concept of uric acid imbalances causing various diseases extended beyond bladder stones and gout to encompass a wide range of ailments, such as depression and mania. This expansion was fueled by the discovery of lithium’s ability to dissolve uric acid deposits in vitro by Alexander Ure in 1843 and Sir Alfred Garrod’s subsequent finding that lithium solutions could dissolve gout uric acid deposits in finger joints in the early 1860s.
-
This question is part of the following fields:
- History Of Psychiatry
-
-
Question 23
Correct
-
What is the life event that Holmes and Rahe consider to be the most stressful?
Your Answer: Death of a spouse
Explanation:Holmes Rahe Stress Scale (Social Readjustment Rating Scale)
In 1967, Holmes and Rahe conducted a study on the impact of stress on illness. They surveyed over 5,000 medical patients and asked them to report whether they had experienced any of 43 life events in the past two years. Each event was assigned a Life Change Unit (LCU) value, which represented its weight for stress. The higher the score, the more likely the patient was to become ill.
The first 10 life events and their corresponding LCU values are listed below.
1. Death of spouse – 100
2. Divorce – 73
3. Marital separation – 65
4. Jail term – 63
5. Death of a close family member – 63
6. Personal illness – 53
7. Marriage – 50
8. Being fired from work – 47
9. Marital reconciliation – 45
10. Retirement – 45This scale is known as the Holmes Rahe Stress Scale of the Social Readjustment Rating Scale. It is still widely used today to assess the impact of life events on stress levels and overall health.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 24
Correct
-
At which type of receptor does agomelatine act as an agonist?
Your Answer: Melatonin
Explanation:Agomelatine: A New Drug for Depression Treatment
Agomelatine is a recently developed medication that is used to treat depression. Its mechanism of action involves acting as an agonist at melatonin M1 and M2 receptors, while also acting as an antagonist at 5HT2C receptors. The effects of melatonin appear to promote sleep, while the 5HT2C antagonism leads to the release of dopamine and norepinephrine in the frontal cortex. Interestingly, serotonin levels do not appear to be affected by this medication.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 25
Incorrect
-
A teenage girl refuses to attend social events with her peers due to her fear of having bad breath, even though others have told her she does not have it. She insists on staying home alone. What is the probable diagnosis?
Your Answer: Piblokto
Correct Answer: Taijin-jikoshu-kyofu
Explanation:Culture-bound syndromes are conditions that are specific to certain cultures and are often accompanied by culturally accepted beliefs and practices for treatment. These syndromes may not fit into the diagnostic criteria of Western medicine and are often unique to certain regions of ethnic groups. Examples of culture-bound syndromes include Taijin-jikoshu-kyofu in Japan, Piblokto in the Arctic, Koro in Malaysia, Locura among Latinos in the United States and Latin America, and Susto among Latinos in the United States and in Mexico, Central America, and South America. These syndromes are often associated with social and cultural factors and may require culturally sensitive approaches to treatment.
-
This question is part of the following fields:
- Diagnosis
-
-
Question 26
Incorrect
-
In comparison to which method of administration, is bioavailability defined as the proportion of a drug that enters the systemic circulation after being administered through a specific route?
Your Answer: Oral
Correct Answer: Intravenous
Explanation:Understanding Bioavailability in Drug Trials
Bioavailability is a crucial factor in drug trials, as it determines the percentage of a drug that reaches the systemic circulation after administration. This can be affected by factors such as absorption and metabolic clearance. For example, if a drug called X is administered orally and only 60% reaches the systemic circulation, its bioavailability is 0.6 of 60%. However, if the same drug is administered intravenously, plasma levels may reach 100%.
One way to potentially increase bioavailability is through the rectal route, which bypasses around two thirds of the first-pass metabolism. This is because the rectum’s venous drainage is two thirds systemic (middle and inferior rectal vein) and one third portal (superior rectal vein). As a result, drugs administered rectally may reach the circulatory system with less alteration and in greater concentrations. Understanding bioavailability and exploring different administration routes can help optimize drug efficacy in clinical trials.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 27
Incorrect
-
The doctor asks the patient the following question:
Sometimes when kids feel really sad, they might have thoughts of hurting themselves. Have you ever had thoughts like that?
What technique is he using?Your Answer: Opened ended question
Correct Answer: Validation
Explanation:To encourage patients to express themselves freely, doctors use various techniques such as validation, confrontation, clarification, facilitation, and open-ended questions. Validation involves making patients feel more comfortable by normalizing their thoughts, feelings, of behaviors. Confrontation involves pointing out something that the patient may be missing of denying. Clarification is used to clarify something that the patient has said. Facilitation involves using verbal and non-verbal cues to encourage patients to continue sharing. Open-ended questions are used to prompt patients to respond in their own words, rather than with a simple yes or no answer.
-
This question is part of the following fields:
- History And Mental State
-
-
Question 28
Incorrect
-
What type of dysarthria is typically caused by widespread damage to the upper motor neurons?
Your Answer: Ataxic dysarthria
Correct Answer: Spastic dysarthria
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.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 29
Incorrect
-
What is the most reliable way to determine someone's current level of intelligence?
Your Answer: Stroop test
Correct Answer: WAIS
Explanation:The field of psychiatry uses various cognitive tests to assess different areas of cognition, including premorbid intelligence, intelligence, memory, attention, language, and others. Some commonly used tests include the National Adult Reading Test (NART) for premorbid intelligence, the Wechsler Adult Intelligence scale (WAIS) and Raven’s Progressive Matrices for intelligence, the Rey-Osterrieth Complex Figure for memory, and the Stroop test, Wisconsin card sorting test, Tower of London, and Continuous Performance Tasks for attention. The Boston naming test and Animal fluency are used to assess language skills. The Halstead-Reitan battery is used specifically for assessing brain damage. These tests are often included in the MRCPsych exams.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 30
Correct
-
Which of the following statements is false about individuals with obsessive-compulsive disorder (OCD)?
Your Answer: Female to male ratio is 3:1
Explanation:While many neuroses are more prevalent in women, OCD only has a slightly higher occurrence in women with a ratio of 1.5 females to every male. Individuals with an anankastic personality may display temporary obsessional symptoms, but they are not more susceptible to OCD than other neurotic disorders. Studies indicate that males with OCD tend to experience symptoms earlier in life, have a greater tendency towards tics, and may have a less favorable prognosis compared to females.
-
This question is part of the following fields:
- Epidemiology
-
-
Question 31
Incorrect
-
Which of the options below does not diminish the effectiveness of the oral contraceptive pill when used together?
Your Answer: Topiramate
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.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 32
Incorrect
-
In what circumstances does Lyonization always take place?
Your Answer: Munchausen's Syndrome
Correct Answer: Klinefelter's syndrome
Explanation:Klinefelter’s syndrome is a condition that occurs when a male has one of more extra copies of the X chromosome in their cells. This extra genetic material interferes with male sexual development, causing the testes to function abnormally and reducing testosterone levels. This can lead to delayed of incomplete puberty, genital abnormalities, gynecomastia, reduced facial and body hair, and infertility. Additionally, individuals with Klinefelter’s syndrome may experience learning disabilities, delayed speech and language development, and a shy personality. The syndrome is typically caused by one extra X chromosome in each cell, but can also be caused by two of three extra X chromosomes. The severity of symptoms increases with the number of extra sex chromosomes. Some individuals with Klinefelter’s syndrome have the extra X chromosome in only some of their cells, which can result in milder symptoms. Lyonization, which occurs when there are multiple X chromosomes in a cell, is present to some degree in all individuals with Klinefelter’s syndrome.
Lyonization: The Process of X-Inactivation
The X chromosome is crucial for proper development and cell viability, containing over 1,000 essential genes. However, females carry two copies of the X chromosome, which can result in a potentially toxic double dose of X-linked genes. To address this imbalance, females undergo a process called Lyonization, of X-inactivation, where one of their two X chromosomes is transcriptionally silenced. The silenced X chromosome then condenses into a compact structure known as a Barr body, which remains in a silent state.
X-inactivation occurs randomly, with no preference for the paternal or maternal X chromosome. It takes place early in embryogenesis, soon after fertilization when the dividing conceptus is about 16-32 cells big. This process occurs in all somatic cells of women, but not in germ cells involved in forming gametes. X-inactivation affects most, but not all, genes on the X chromosome. If a cell has more than two X chromosomes, the extra Xs are also inactivated.
-
This question is part of the following fields:
- Genetics
-
-
Question 33
Incorrect
-
What is a true statement about the Edinburgh Postnatal Depression Scale?
Your Answer: It includes 12 questions
Correct Answer: It is a self-report questionnaire
Explanation:Edinburgh Postnatal Depression Scale (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire designed to screen for postnatal depression in primary care settings. It should only be used to assess a women’s mood over the past seven days and cannot be used to diagnose depression. The EPDS excludes some symptoms common in the perinatal period, such as tiredness and irritability, as they do not differentiate between depressed and non-depressed postnatal women. Women are asked to select one of four responses that most closely represents how they have felt over the past seven days. Scores for the 10 items are added together, with a score of 0-9 indicating a low likelihood of depression, 10-12 indicating a moderate likelihood, and 13 of more indicating a high likelihood. The statements include feelings of happiness, sadness, anxiety, and thoughts of self-harm.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 34
Correct
-
In Piaget's theory, what is the term used to describe the process by which individuals try to make sense of new experiences by relating them to their existing knowledge structures?
Your Answer: Assimilation
Explanation:Piaget’s cognitive theory involves the use of existing patterns of knowledge and behavior, known as schemas, through the process of assimilation. However, when faced with new situations, these schemas may need to be modified, which is known as accommodation. The theory is comprised of three main components: schemas, processes that facilitate the transition between stages (equilibrium, assimilation, and accommodation), and four stages of development: sensorimotor (0-2 years), preoperational (2-7 years), concrete operational (7-11 years), and formal operational (11+ years).
-
This question is part of the following fields:
- Psychological Development
-
-
Question 35
Incorrect
-
An adult patient while receiving treatment in a hospital ward thinks that they are in their own house that has magically turned into the hospital. What type of condition does this scenario illustrate?
Your Answer: Derealisation
Correct Answer: Reduplicative paramnesia
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 36
Incorrect
-
What is the correct statement about the recombination fraction?
Your Answer: Recombination fractions can take values from 0-100%
Correct Answer: It is a measure of the distance between two loci
Explanation:Recombination Fraction: A Measure of Distance Between Loci
When two loci are located on different chromosomes, they segregate independently during meiosis. However, if they are on the same chromosome, they tend to segregate together, unless crossing over occurs. Crossing over is a process in meiosis where two homologous chromosomes exchange genetic material, resulting in the shuffling of alleles. The likelihood of crossing over between two loci on a chromosome decreases as their distance from each other increases.
Hence, blocks of alleles on a chromosome tend to be transmitted together through generations, forming a haplotype. The recombination fraction is a measure of the distance between two loci on a chromosome. The closer the loci are, the lower the recombination fraction, and the more likely they are to be transmitted together. Conversely, the further apart the loci are, the higher the recombination fraction, and the more likely they are to be separated by crossing over. The recombination fraction can range from 0% if the loci are very close to 50% if they are on different chromosomes.
-
This question is part of the following fields:
- Genetics
-
-
Question 37
Correct
-
A patient prescribed quetiapine (500mg once daily) at the age of 65 had a recent ECG which showed a QTc interval of 510 ms. Which of the following would be the most appropriate next step?:
Your Answer: Stop quetiapine completely and then switch to aripiprazole and refer to cardiology
Explanation:Aripiprazole and olanzapine are preferred over haloperidol due to its high impact on the QTc interval. Risperidone can also be considered as a viable option in cases where the QTc interval is elevated.
Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 38
Incorrect
-
What is the most frequent organic cause of anxiety symptoms?
Your Answer: Hyperparathyroidism
Correct Answer: Hypoglycaemia
Explanation:Anxiety can also be caused by organic factors such as alcohol withdrawal, drug intoxication of withdrawal, thyrotoxicosis, and paroxysmal supraventricular tachycardias. While phaeochromocytoma is a rare cause, carcinoid does not typically result in anxiety. It is more common for depression to be a presenting symptom of carcinoma of the bronchus and hyperparathyroidism.
-
This question is part of the following fields:
- Aetiology
-
-
Question 39
Incorrect
-
According to Kohlberg, which of the following corresponds to the 3rd stage of moral development?
Your Answer: Law and order orientation
Correct Answer: Interpersonal accord and conformity
Explanation:Kohlberg’s Six Stages of Moral Development
Kohlberg’s theory of moral development consists of six stages that can be categorized into three levels. The first level is the preconventional stage, which is characterized by obedience and punishment orientation, where the focus is on the direct consequences of actions and unquestioning deference to power. The second stage is the self-interest orientation, where right behavior is defined purely by what is in the individual’s own interest.
The second level is the conventional stage, which is characterized by interpersonal accord and conformity, where the focus is on how the individual will appear to others. The behavior should accord with a consensus view on what is good. The second stage is the authority and social order obedience driven, where what is lawful is judged to be morally right. Right behavior is dictated by societal rules, and there is a greater respect for social order and the need for laws.
The third level is the postconventional stage, which is characterized by the social contract orientation, where individual rights determine behavior. The individual views laws and rules as flexible tools for improving human purposes. The fourth stage is the universal ethical principles orientation, where the right action is the one that is consistent with abstract reasoning using universal ethical principles.
It is important to note that the age ranges for Kohlberg’s developmental stages are rough guides, and sources vary widely. Kohlberg developed his stage theory following an experiment he conducted on 72 boys aged 10-16. However, the theory is criticized as sexist as it only included boys.
-
This question is part of the following fields:
- Psychological Development
-
-
Question 40
Correct
-
What is the characteristic feature that is specific to Wilson's disease?
Your Answer: Kayser-Fleischer Ring
Explanation:While other conditions may also present with the same symptoms, a Kayser-Fleischer Ring, characterized by a golden-brown corneal ring due to copper deposits at the Descemet’s membrane, is considered a definitive indicator of Wilson’s disease.
Understanding Wilson’s Disease: Causes, Symptoms, and Management
Wilson’s disease, also known as hepatolenticular degeneration, is a genetic disorder that affects copper storage in the body. This condition is caused by a defect in the ATP7B gene, which leads to the accumulation of copper in the liver and brain. The onset of symptoms usually occurs between the ages of 10 and 25, with liver disease being the most common presentation in children and neurological symptoms in young adults.
The excessive deposition of copper in the tissues can cause a range of symptoms, including hepatitis, cirrhosis, basal ganglia degeneration, speech and behavioral problems, asterixis, chorea, dementia, Kayser-Fleischer rings, sunflower cataract, renal tubular acidosis, haemolysis, and blue nails. Diagnosis is based on reduced serum ceruloplasmin, reduced serum copper, and increased 24-hour urinary copper excretion.
The traditional first-line treatment for Wilson’s disease is penicillamine, which chelates copper. Trientine hydrochloride is an alternative chelating agent that may become first-line treatment in the future. Tetrathiomolybdate is a newer agent that is currently under investigation.
In summary, Wilson’s disease is a genetic disorder that affects copper storage in the body, leading to a range of symptoms that can affect the liver, brain, and eyes. Early diagnosis and treatment are essential to prevent complications and improve outcomes.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 41
Incorrect
-
What is a known factor that can lead to hypercalcemia?
Your Answer: Fluoxetine
Correct Answer: Lithium
Explanation:Understanding Hypercalcemia and its Causes
Hypercalcemia is a medical condition that can cause fatigue, confusion, and depression. It is characterized by the classic symptoms of bone pain, abdominal pain, renal stones, and psychic moans. This condition can be triggered by the use of lithium and thiazide diuretics.
It is important to note that around 50% of serum calcium is bound to plasma proteins, particularly albumin. This means that any abnormalities in albumin levels can lead to inaccurate calcium results. To address this issue, a corrected calcium test is usually included in a patient’s blood work to ensure accurate diagnosis and treatment.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 42
Incorrect
-
The patient, a 25-year-old male who was recently started on risperidone, presents to the clinic with complaints of decreased libido and gynecomastia. These symptoms may be attributed to the blockade of D-2 receptors in which of the following pathways?
Your Answer: Nigrostriatal
Correct Answer: Tuberoinfundibular
Explanation:Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 43
Incorrect
-
What is the maximum duration of a normal QTc interval in an adult male?
Your Answer: 460
Correct Answer: 440
Explanation:While the upper limit technically reaches 439, it is evident that 440 is the optimal choice among the options provided.
Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 44
Correct
-
What is the term used to describe learning that occurs as a result of the consequences of behaviours?
Your Answer: Operant conditioning
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.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 45
Incorrect
-
Which atypical antipsychotic has the most extended half-life?
Your Answer: Risperidone
Correct Answer: Aripiprazole
Explanation:Knowing the half life of a drug is important in determining the steady state concentration, which occurs when absorption and elimination reach an equilibrium after repeated doses. This equilibrium depends on factors such as dose, time between doses, and the drug’s elimination half life. Typically, steady state is achieved after four to five half lives. The following are the half lives of some atypical antipsychotics: Aripiprazole – 90 hours, Clozapine – 16 hours, Olanzapine – 30 hours, Risperidone – 15 hours, and Quetiapine – 6 hours.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 46
Incorrect
-
Which of the following is not preferentially metabolized by MAO-A?
Your Answer: Adrenaline
Correct Answer: Phenethylamine
Explanation:Phenethylamine is NOT a metabolite of MAO-A, but rather of MAO-B.
Monoamine Oxidase (MAO)
Monoamine oxidase (MAO) is an enzyme that plays a crucial role in the metabolism of various neurotransmitters and hormones in the body. There are two forms of MAO, namely MAO-A and MAO-B. MAO-A is responsible for metabolising dopamine, serotonin, noradrenaline, adrenaline, and melatonin, while MAO-B metabolises dopamine and phenylethylamine. These neurotransmitters and hormones are essential for regulating mood, emotions, and behaviour. Any imbalance in their levels can lead to various mental health disorders such as depression, anxiety, and bipolar disorder. Therefore, MAO inhibitors are commonly used as antidepressants and anxiolytics to regulate the levels of these neurotransmitters and hormones in the body.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 47
Incorrect
-
Which of the following is associated with a senile pupil?
Your Answer: Normal response to accommodation but sluggish response to light
Correct Answer: Sluggish response to light and accommodation
Explanation:Senile Pupil: A Common Age-Related Condition
The senile pupil, also known as senile miosis, is a condition commonly observed in older individuals. It is characterized by a small pupil that does not dilate in the dark, and may also be associated with reduced reaction to light and accommodation. This condition is often a result of age-related changes in the muscles that control the pupil, and can be exacerbated by certain medications of medical conditions. While it may not cause significant vision problems, it is important for individuals with senile pupil to have regular eye exams to monitor any changes in their vision and ensure proper eye health.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 48
Incorrect
-
What type of antidepressant is classified as specific for noradrenaline and serotonin?
Your Answer: Trazodone
Correct Answer: Mirtazapine
Explanation:Antidepressants: Mechanism of Action
Antidepressants are a class of drugs used to treat depression and other mood disorders. The mechanism of action of antidepressants varies depending on the specific drug. Here are some examples:
Mirtazapine is a noradrenaline and serotonin specific antidepressant (NaSSa). It works by blocking certain receptors in the brain, including 5HT-1, 5HT-2, 5HT-3, and H1 receptors. It also acts as a presynaptic alpha 2 antagonist, which stimulates the release of noradrenaline and serotonin.
Venlafaxine and duloxetine are both serotonin and noradrenaline reuptake inhibitors (SNRIs). They work by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Reboxetine is a noradrenaline reuptake inhibitor (NRI). It works by blocking the reuptake of noradrenaline, which increases its availability in the brain.
Bupropion is a noradrenaline and dopamine reuptake inhibitor (NDRI). It works by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Trazodone is a weak serotonin reuptake inhibitor (SRI) and 5HT agonist. It works by increasing the availability of serotonin in the brain.
St John’s Wort is a natural supplement that has been used to treat depression. It has a weak monoamine oxidase inhibitor (MAOI) effect and a weak SNRI effect.
In summary, antidepressants work by increasing the availability of certain neurotransmitters in the brain, such as serotonin, noradrenaline, and dopamine. The specific mechanism of action varies depending on the drug.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 49
Incorrect
-
A 40-year-old male is experiencing difficulty walking of standing normally. He presents to the Emergency department and is observed swaying from side to side, almost falling before recovering. What is the specific name for this condition?
Your Answer: Conversion disorder
Correct Answer: Blocq's disease
Explanation:Blocq’s disease, also known as astasia-abasia, is a conversion symptom characterized by an abnormal gait that is not indicative of any organic lesion. Hypochondriasis is excessive worry about having a serious illness despite the absence of a medical condition. Malingering involves fabricating symptoms for secondary gain, while somatization is a chronic condition with multiple physical complaints for which no physical cause can be found and is associated with frequent medical contact.
-
This question is part of the following fields:
- Descriptive Psychopathology
-
-
Question 50
Incorrect
-
A researcher studying suicide prevention strategies in elderly populations is gathering information on the prevalence of suicide. What was the rate of suicide in the United Kingdom in 2011 among individuals aged 65 and older?
Your Answer: The highest suicide rates in males was in 45- to 59-year-olds
Correct Answer: UK suicide rates increased significantly between 2010 and 2011
Explanation:Between 2007 and 2011, there was a significant increase in the suicide rate among males aged 45 to 59, with 22.2 deaths per 100,000 population in 2011. The highest suicide rate overall was observed in males aged 30 to 44, with 23.5 deaths per 100,000 population in 2011. For females, the highest suicide rate was seen in the 45- to 59-year-old age group, with 7.3 deaths per 100,000 population in 2011. In 2011, there were 4,552 male suicides (a rate of 18.2 suicides per 100,000 population) and 1,493 female suicides (5.6 per 100,000 population).
-
This question is part of the following fields:
- Prevention Of Psychological Disorder
-
-
Question 51
Correct
-
Which one of the following statements would be correct concerning phobias in a 3-year-old girl?
Your Answer: A 3-year-old girl will be scared of monsters
Explanation:The types of fear that arise during childhood and adolescence vary depending on the age of the individual. Fear of new things, like strangers, is common at 6 months and peaks at 2 years old. Fear of heights typically starts at 6 to 8 months and intensifies when the child begins to walk. From 3 to 5 years old, children often fear animals, the dark, and monsters. Between 6 and 11 years old, fear of embarrassing social situations, such as being made fun of, may develop. During adolescence, fear of death, failure, social events like parties, and even nuclear war may become more prevalent.
-
This question is part of the following fields:
- Psychological Development
-
-
Question 52
Incorrect
-
What category of adverse drug reaction does respiratory depression caused by opioids fall under?
Your Answer: Type D
Correct Answer: Type A
Explanation:The MHRA categorizes adverse drug reactions into five types. Type A reactions occur when a drug’s usual pharmacological actions are amplified at the normal therapeutic dose, and are typically dose-dependent. Type B reactions are unexpected and not related to the drug’s known pharmacological actions. Type C reactions persist for a prolonged period of time, while Type D reactions become apparent after a delay. Type E reactions are associated with the withdrawal of a medication.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 53
Incorrect
-
What is the term used to describe an intense and brief emotional reaction to a minor trigger?
Your Answer: Emotional reflex
Correct Answer: Emotional lability
Explanation:Understanding Emotional Lability
Emotional lability is a condition characterized by an excessive and brief emotional response to a minor stimulus. It is a common symptom of various neurological and psychiatric disorders, including traumatic brain injury, multiple sclerosis, Parkinson’s disease, bipolar disorder, and borderline personality disorder. People with emotional lability may experience sudden and intense mood swings, such as crying, laughing, anger, of irritability, that are out of proportion to the situation.
One of the most challenging aspects of emotional lability is the lack of control over one’s emotions. Pathological crying of laughing is a common manifestation of emotional lability, where a person may burst into tears of laughter without any apparent reason of context. This can be embarrassing, distressing, and socially isolating, as it may be perceived as a sign of weakness, instability, of immaturity.
Treatment for emotional lability depends on the underlying cause and severity of the symptoms. In some cases, medication, such as antidepressants, antipsychotics, of mood stabilizers, may be prescribed to regulate the mood and reduce the frequency and intensity of emotional outbursts. Psychotherapy, such as cognitive-behavioral therapy of dialectical behavior therapy, can also help individuals with emotional lability to develop coping skills, emotional regulation strategies, and interpersonal communication skills.
It is important to note that emotional lability is not a character flaw of a personal weakness, but a medical condition that requires proper diagnosis and treatment. Seeking professional help from a qualified healthcare provider can help individuals with emotional lability to improve their quality of life, enhance their relationships, and regain their emotional stability and resilience.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 54
Incorrect
-
Which of the following characteristics would be associated with an individual possessing referent power?
Your Answer: Wealthy
Correct Answer: Charismatic
Explanation:Referent power is the capacity of a leader to sway a follower’s actions based on the follower’s allegiance, esteem, camaraderie, adoration, fondness, of aspiration for validation. Typically, these leaders possess charisma.
Power Theory
French and Raven (1959) developed the 5 base theory of power, which identifies five types of power. These include legitimate power, which is held by an individual in an organization, referent power, which is held by a person with charisma who people gravitate towards, expert power, which is held by a person with specialist skills of knowledge, reward power, which is held by a person in a position to provide rewards, and coercive power, which is held by a person who has the ability to apply negative influences such as demotion. Other terms to be aware of include outcome power, which is the power of a person to bring about outcomes, social power, which is the power of a person to influence others so that they will bring about outcomes, and counterpower, which is the power of the oppressed to counterbalance the elite.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 55
Incorrect
-
Out of the options provided, which term is not classified as a personality disorder according to the DSM-5?
Your Answer:
Correct Answer: Passive-aggressive
Explanation:The DSM-III previously utilized the term passive-aggressive personality disorder.
Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 56
Incorrect
-
What is the frequency of the A allele in the population of 400 diploid individuals, given that 15 individuals have the AA genotype and 25 have the Aa genotype?
Your Answer:
Correct Answer: 0.07
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.
-
This question is part of the following fields:
- Genetics
-
-
Question 57
Incorrect
-
What is the typical number of autosomes found in a human somatic cell?
Your Answer:
Correct Answer: 44
Explanation:Aneuploidy: Abnormal Chromosome Numbers
Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.
Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.
The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.
-
This question is part of the following fields:
- Genetics
-
-
Question 58
Incorrect
-
From where does the nerve that originates in the medulla oblongata come?
Your Answer:
Correct Answer: Vagus
Explanation:Overview of Cranial Nerves and Their Functions
The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.
The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.
The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.
The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.
The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.
The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.
The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.
The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 59
Incorrect
-
A 25-year-old female with bipolar affective disorder fails to follow her doctor's advice and purchases ampicillin online to treat a viral fever. What is the term used to describe this type of medication non-compliance?
Your Answer:
Correct Answer: Errors of taking additional medication not prescribed
Explanation:Schwartz et al. identified five types of errors in drug adherence. These include errors of omission, errors of purpose, errors of dosage, errors of timing and sequence, and taking additional medication not prescribed by the doctor. An example of errors of purpose is when a patient takes medication for the wrong reason. Other types of errors include not taking the medication, taking the wrong dosage, and taking medications at the wrong time and sequence.
-
This question is part of the following fields:
- Advanced Psychological Processes And Treatments
-
-
Question 60
Incorrect
-
How would you define a term that refers to a mark of shame of dishonor that distinguishes an individual from their peers?
Your Answer:
Correct Answer: Stigma
Explanation:Stigma refers to a characteristic of behavior that is deemed shameful by society and causes an individual to be viewed as different from others.
Stigma is a term used to describe the negative attitudes and beliefs that people hold towards individuals who are different from them. There are several types of stigma, including discredited and discreditable stigma, felt stigma, enacted stigma, and courtesy stigma. Discredited stigma refers to visible stigmas such as race, gender, of physical disability, while discreditable stigma refers to concealable stigmas such as mental illness of HIV infection. Felt stigma is the shame and fear of discrimination that prevents people from seeking help, while enacted stigma is the experience of unfair treatment by others. Finally, courtesy stigma refers to the stigma that attaches to those who are associated with a stigmatized person.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 61
Incorrect
-
What is the recommended duration of treatment for patients with schizophrenia who are starting on an antipsychotic medication?
Your Answer:
Correct Answer: 1-2 years
Explanation:Schizophrenia and Duration of Treatment
The NICE guidelines do not provide a specific recommendation on the duration of treatment for schizophrenia. However, they do caution patients about the risks of stopping medication.
According to the guidelines, patients should be informed that there is a high risk of relapse if they stop taking their medication within the next 1-2 years. This suggests that long-term treatment may be necessary to manage symptoms and prevent relapse. It is important for patients to understand the potential consequences of stopping medication and to work closely with their healthcare provider to develop a treatment plan that meets their individual needs.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 62
Incorrect
-
You are provided with a set of blood test outcomes that show serum levels for different medications. Which of the following falls outside the typical range for an elderly patient?
Your Answer:
Correct Answer: Lithium 1.9 mmol/L
Explanation: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
-
-
Question 63
Incorrect
-
A 45-year-old male alcoholic presents to the Emergency department with symptoms of ataxia, abnormal eye movements, confusion, and signs of dehydration. He also has a low blood sugar level. What is the initial treatment that should be given to this patient?
Your Answer:
Correct Answer: Thiamine IV, IV replacement of other vitamins, then both orally thereafter
Explanation:Wernicke’s encephalopathy is a medical emergency that requires immediate replacement of thiamine. The preferred route of administration is intravenous (IV). It is important to note that correcting hypoglycemia should not be attempted before thiamine replenishment, as a large dose of sugar, especially glucose, can worsen the encephalopathy. Rehydration to restore blood volume should follow as needed.
In the UK, Pabrinex is the usual treatment for thiamine replacement, which also contains vitamins B2, B3, B6, and C. Parenteral treatment is given for at least 5 days. The prognosis depends on the severity of the condition. Early treatment leads to rapid and complete recovery. However, established Wernicke’s encephalopathy can have serious long-term consequences, and patients may require permanent inpatient care.
Source: https://www.nice.org.uk/guidance/cg100/chapter/Recommendations#wernickes-encephalopathy
https://academic.oup.com/alcalc/article/48/4/514/533760 -
This question is part of the following fields:
- Diagnosis
-
-
Question 64
Incorrect
-
What type of apraxia is demonstrated by the difficulty in reproducing intersecting pentagons on the MMSE?
Your Answer:
Correct Answer: Constructional
Explanation:Apraxia: Understanding the Inability to Carry Out Learned Voluntary Movements
Apraxia is a neurological condition that affects a person’s ability to carry out learned voluntary movements. It is important to note that this condition assumes that everything works and the person is not paralyzed. There are different types of apraxia, each with its own set of symptoms and characteristics.
Limb kinetic apraxia is a type of apraxia that affects a person’s ability to make fine of delicate movements. This can include tasks such as buttoning a shirt of tying shoelaces.
Ideomotor apraxia, on the other hand, is an inability to carry out learned tasks when given the necessary objects. For example, a person with ideomotor apraxia may try to write with a hairbrush instead of using it to brush their hair.
Constructional apraxia affects a person’s ability to copy a picture of combine parts of something to form a whole. This can include tasks such as building a puzzle of drawing a picture.
Ideational apraxia is an inability to follow a sequence of actions in the correct order. For example, a person with ideational apraxia may struggle to take a match out of a box and strike it with their left hand.
Finally, oculomotor apraxia affects a person’s ability to control eye movements. This can make it difficult for them to track moving objects of read smoothly.
Overall, apraxia can have a significant impact on a person’s ability to carry out everyday tasks. However, with the right support and treatment, many people with apraxia are able to improve their abilities and maintain their independence.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 65
Incorrect
-
Who is the well-known British psychiatrist, known for his affiliation with the antipsychiatry movement, and is recognized for his statement that 'Madness does not necessarily have to be a complete breakdown, but can also be a breakthrough'?
Your Answer:
Correct Answer: Laing
Explanation:Apart from Bleuler who is Swiss, all the other psychiatrists in the list of options are German – Kraepelin and…
Antipsychiatry is a movement that emerged in the 1960s and challenges the traditional medical model of mental illness. It argues that mental illnesses are not biological of medical conditions but rather social constructs that reflect deviations from social norms. The movement has been associated with several famous figures, including Thomas Szasz, R.D. Laing, Michel Foucault, and Franco Basaglia. These individuals have criticized the psychiatric profession for its use of involuntary hospitalization, medication, and other forms of coercion in the treatment of mental illness. They have also advocated for alternative approaches to mental health care, such as community-based care and psychotherapy. Despite its controversial nature, the antipsychiatry movement has had a significant impact on the field of mental health and continues to influence the way we think about and treat mental illness today.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 66
Incorrect
-
A GP contacts you with concerns about a patient who was prescribed phenelzine during their hospital stay and has now been hospitalized due to significant hypertension. Which medication taken by the patient is the most probable cause of this interaction?
Your Answer:
Correct Answer: Dextromethorphan
Explanation:Dextromethorphan is a medication used to suppress coughing and is commonly found in various cold and cough remedies available without a prescription. It is important to note that it can interact with MAOIs, which are a type of medication used to treat depression and other mental health conditions.
MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions
First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).
MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.
The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.
Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.
Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 67
Incorrect
-
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.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 68
Incorrect
-
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.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 69
Incorrect
-
Which of the following is the best example of a leading question?
Your Answer:
Correct Answer: So, when you took the overdose you didn't want to die, did you?
Explanation:Techniques for Conducting Effective Interviews: Avoiding Leading Questions
One technique to avoid when conducting interviews is the use of leading questions. These are questions that suggest a particular answer of response, and can result in inaccurate of biased information. Instead, interviewers should strive to ask open-ended questions that allow the respondent to provide their own thoughts and opinions. By avoiding leading questions, interviewers can gather more reliable and unbiased information from their subjects. Additionally, interviewers should be mindful of their tone and body language, as these can also influence the responses they receive. Overall, effective interviewing requires careful preparation and a focus on creating a comfortable and open environment for the respondent.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 70
Incorrect
-
What is the primary mechanism of action for buspirone, an agent used to treat anxiety?
Your Answer:
Correct Answer: 5HT1a partial agonism
Explanation:Buspirone is a medication that acts as a partial agonist for the 5HT1a receptor, and its chemical structure is distinct from that of benzodiazepines.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 71
Incorrect
-
What substance can be safely consumed along with monoamine oxidase inhibitors (MAOIs)?
Your Answer:
Correct Answer: Paracetamol
Explanation:Taking paracetamol with MAOIs is safe, but other medications and certain foods and drinks should be avoided to prevent the cheese reaction. The list of high-tyramine foods is provided in the drug’s leaflet. MAOIs are not commonly prescribed in primary care.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 72
Incorrect
-
Which of the following describes separation anxiety among toddlers when temporarily separated from their primary caregiver?
Your Answer:
Correct Answer: Spitz
Explanation:René Spitz coined the term anaclitic depression to describe the negative impact on children who are separated from their primary caregiver, such as during a hospital stay. In extreme cases, this can lead to hospitalism. Although this type of depression can hinder a child’s development, recovery is likely if the separation from the mother does not exceed three months. Ainsworth is known for her work on the strange situation procedure, while Bowlby focused on attachment and maternal deprivation. Main is associated with the adult attachment interview, and Rutter distinguished between privation and deprivation, with the former referring to a failure to form attachments.
-
This question is part of the following fields:
- Advanced Psychological Processes And Treatments
-
-
Question 73
Incorrect
-
What is a true statement about the neocortex?
Your Answer:
Correct Answer: It contains both pyramidal and nonpyramidal cells
Explanation:The Cerebral Cortex and Neocortex
The cerebral cortex is the outermost layer of the cerebral hemispheres and is composed of three parts: the archicortex, paleocortex, and neocortex. The neocortex accounts for 90% of the cortex and is involved in higher functions such as thought and language. It is divided into 6-7 layers, with two main cell types: pyramidal cells and nonpyramidal cells. The surface of the neocortex is divided into separate areas, each given a number by Brodmann (e.g. Brodmann’s area 17 is the primary visual cortex). The surface is folded to increase surface area, with grooves called sulci and ridges called gyri. The neocortex is responsible for higher cognitive functions and is essential for human consciousness.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 74
Incorrect
-
Which statement accurately describes the CATIE study?
Your Answer:
Correct Answer: Olanzapine was found to be more effective than the other atypical antipsychotics used in phase I
Explanation:Olanzapine was found to have the highest duration of treatment before discontinuation due to inadequate efficacy, the longest period of successful treatment, and the lowest number of hospitalizations caused by worsening of schizophrenia among the patients.
CATIE Study: Comparing Antipsychotic Medications for Schizophrenia Treatment
The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study, funded by the National Institute of Mental Health (NIMH), was a nationwide clinical trial that aimed to compare the effectiveness of older and newer antipsychotic medications used to treat schizophrenia. It is the largest, longest, and most comprehensive independent trial ever conducted to examine existing therapies for schizophrenia. The study consisted of two phases.
Phase I of CATIE compared four newer antipsychotic medications to one another and an older medication. Participants were followed for 18 months to evaluate longer-term patient outcomes. The study involved over 1400 participants and was conducted at various treatment sites, representative of real-life settings where patients receive care. The results from CATIE are applicable to a wide range of people with schizophrenia in the United States.
The medications were comparably effective, but high rates of discontinuation were observed due to intolerable side-effects of failure to adequately control symptoms. Olanzapine was slightly better than the other drugs but was associated with significant weight gain as a side-effect. Surprisingly, the older, less expensive medication (perphenazine) used in the study generally performed as well as the four newer medications. Movement side effects primarily associated with the older medications were not seen more frequently with perphenazine than with the newer drugs.
Phase II of CATIE sought to provide guidance on which antipsychotic to try next if the first failed due to ineffectiveness of intolerability. Participants who discontinued their first antipsychotic medication because of inadequate management of symptoms were encouraged to enter the efficacy (clozapine) pathway, while those who discontinued their first treatment because of intolerable side effects were encouraged to enter the tolerability (ziprasidone) pathway. Clozapine was remarkably effective and was substantially better than all the other atypical medications.
The CATIE study also looked at the risk of metabolic syndrome (MS) using the US National Cholesterol Education Program Adult Treatment Panel criteria. The prevalence of MS at baseline in the CATIE group was 40.9%, with female patients being three times as likely to have MS compared to matched controls and male patients being twice as likely.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 75
Incorrect
-
What conditions can be identified through administering a clock drawing test?
Your Answer:
Correct Answer: Constructional dyspraxia
Explanation:The clock drawing test (CDT) is primarily utilized as a tool for screening cognitive impairment and dementia, as well as measuring spatial dysfunctions and neglect. However, it is not effective in detecting abnormal time perception, disorientation, of poor attention. For identifying disorientation to time, place, and person, the mini-mental state examination (MMSE) is a more suitable screening tool. Additionally, while abnormal clock drawing may occur in other cognitive impairments, CDT is not utilized for detecting episodic memory loss.
-
This question is part of the following fields:
- Cognitive Assessment
-
-
Question 76
Incorrect
-
A 37-year-old woman is experiencing constant fatigue~ sadness~ and tearfulness~ as well as poor sleep. These symptoms have been present for the past 3 months. She recently delivered her third child 4 months ago. She has lost interest in socializing~ work~ and sex~ and feels guilty for not being able to feel happy despite having a healthy baby and a supportive family. What is the most probable diagnosis?
Your Answer:
Correct Answer: Postpartum depression
Explanation:It is highly probable that the individual is experiencing postpartum depression, as all the symptoms are characteristic and have manifested within a year of giving birth. While the ‘baby blues’ is a brief and immediate response, postnatal depression typically develops within two to three months after delivery.
-
This question is part of the following fields:
- Diagnosis
-
-
Question 77
Incorrect
-
What factor is involved in the development of Alzheimer's disease?
Your Answer:
Correct Answer: All of the above
Explanation:Genetics plays a role in the development of Alzheimer’s disease, with different genes being associated with early onset and late onset cases. Early onset Alzheimer’s, which is rare, is linked to three genes: amyloid precursor protein (APP), presenilin one (PSEN-1), and presenilin two (PSEN-2). The APP gene, located on chromosome 21, produces a protein that is a precursor to amyloid. The presenilins are enzymes that cleave APP to produce amyloid beta fragments, and alterations in the ratios of these fragments can lead to plaque formation. Late onset Alzheimer’s is associated with the apolipoprotein E (APOE) gene on chromosome 19, with the E4 variant increasing the risk of developing the disease. People with Down’s syndrome are also at high risk of developing Alzheimer’s due to inheriting an extra copy of the APP gene.
-
This question is part of the following fields:
- Genetics
-
-
Question 78
Incorrect
-
A 65-year-old individual reports experiencing a range of side effects after commencing a combination of medications. Which of these symptoms would lead you to suspect that lithium is the culprit?
Your Answer:
Correct Answer: Metallic taste
Explanation: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
-
-
Question 79
Incorrect
-
A junior colleague calls you about a patient on one of the pediatric wards. They have fallen over and sustained a head injury. They tell you that the patient is orientated in time, place, and person, is opening their eyes when spoken to, and obeys commands such as put you finger to your nose. What is the patients Glasgow Coma Scale score?
Your Answer:
Correct Answer: 14
Explanation:The total score of E3 V5 M6 is 14.
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
-
-
Question 80
Incorrect
-
What is the most frequently reported side-effect of methylphenidate?
Your Answer:
Correct Answer: Nausea
Explanation:ADHD medications can be classified into stimulant and non-stimulant drugs. The therapeutic effects of these drugs are believed to be mediated through the action of noradrenaline in the prefrontal cortex. Common side effects of these drugs include decreased appetite, insomnia, nervousness, headache, and nausea. Stimulant drugs like dexamphetamine, methylphenidate, and lisdexamfetamine inhibit the reuptake of dopamine and noradrenaline. Non-stimulant drugs like atomoxetine, guanfacine, and clonidine work by increasing noradrenaline levels in the synaptic cleft through different mechanisms. The most common side effects of these drugs are decreased appetite, somnolence, headache, and abdominal pain.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 81
Incorrect
-
What drug states are capable of eliciting a biological response?
Your Answer:
Correct Answer: A drug unbound in the plasma
Explanation:The biological response to a drug can only be triggered by the portion of the drug that is not bound.
Drug Distribution in the Body
After being absorbed, drugs can distribute to different parts of the body, such as fat, plasma, muscle, brain tissue, and glands like the thyroid. However, for a drug to have an effect, it must be present in the plasma in an unbound state. This means that the drug molecules are not attached to any other molecules and are free to interact with their target receptors. The concentration of unbound drug in the plasma is what determines the drug’s effectiveness and potential side effects. Therefore, understanding a drug’s distribution in the body is crucial for determining the appropriate dosage and monitoring its effects.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 82
Incorrect
-
A 35-year-old man from a Latin American background arrives at the emergency department with a chief complaint of overwhelming anxiety. He expresses concern that his soul has departed from his body. What is the name of this cultural affliction?
Your Answer:
Correct Answer: Susto
Explanation:Susto is an anxiety disorder prevalent in South and Central America that is linked to the loss of soul. It typically occurs after experiencing a traumatic emotional of physical event.
Amok is a dissociative state that is more commonly observed in Malaysia. It is characterized by symptoms such as neurasthenia, depersonalization, rage, automatism, and violent acts.
Koro is a belief that the penis is shrinking and will retract into the abdomen, leading to death.
Latah is a condition similar to Tourette’s syndrome, where an exaggerated startle response results in abnormal behaviors.
Wendigo is a depressive disorder that involves the delusion of becoming cannibalistic. It is primarily observed in Native American communities.
-
This question is part of the following fields:
- Stigma And Culture
-
-
Question 83
Incorrect
-
As per the classification of the Registrar General, how are married mothers who are unemployed categorized?
Your Answer:
Correct Answer: According to their husband's occupation
Explanation:Social Class Determination and the Registrar General’s Classification System
The Registrar General’s classification system, which was implemented in 1911, has been a useful tool in categorizing population groups. However, it can pose challenges when classifying individuals who are unemployed, part-time workers, of retirees.
Traditionally, social class has been determined by occupation, with professionals, landowners, and higher managerial positions falling under Class I. Class II includes intermediate occupations, while skilled workers are classified under Class III. Semi-skilled workers are categorized under Class IV, and unskilled workers fall under Class V.
However, students and retirees do not fit neatly into this classification system. They are often excluded from the traditional social class structure and are instead given their own category. This highlights the limitations of the Registrar General’s classification system and the need for more inclusive and comprehensive methods of categorizing population groups.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 84
Incorrect
-
What is the condition caused by inheriting a deletion of chromosome 15q from the father?
Your Answer:
Correct Answer: Prader-Willi
Explanation:Genomic Imprinting and its Role in Psychiatric Disorders
Genomic imprinting is a phenomenon where a piece of DNA behaves differently depending on whether it is inherited from the mother of the father. This is because DNA sequences are marked of imprinted in the ovaries and testes, which affects their expression. In psychiatry, two classic examples of genomic imprinting disorders are Prader-Willi and Angelman syndrome.
Prader-Willi syndrome is caused by a deletion of chromosome 15q when inherited from the father. This disorder is characterized by hypotonia, short stature, polyphagia, obesity, small gonads, and mild mental retardation. On the other hand, Angelman syndrome, also known as Happy Puppet syndrome, is caused by a deletion of 15q when inherited from the mother. This disorder is characterized by an unusually happy demeanor, developmental delay, seizures, sleep disturbance, and jerky hand movements.
Overall, genomic imprinting plays a crucial role in the development of psychiatric disorders. Understanding the mechanisms behind genomic imprinting can help in the diagnosis and treatment of these disorders.
-
This question is part of the following fields:
- Genetics
-
-
Question 85
Incorrect
-
Which reflex involves the oculomotor, trochlear, and abducent nerve in its motor component?
Your Answer:
Correct Answer: Vestibulo-ocular
Explanation:Cranial Nerve Reflexes
When it comes to questions on cranial nerve reflexes, it is important to match the reflex to the nerves involved. Here are some examples:
– Pupillary light reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
– Accommodation reflex: involves the optic nerve (sensory) and oculomotor nerve (motor).
– Jaw jerk: involves the trigeminal nerve (sensory and motor).
– Corneal reflex: involves the trigeminal nerve (sensory) and facial nerve (motor).
– Vestibulo-ocular reflex: involves the vestibulocochlear nerve (sensory) and oculomotor, trochlear, and abducent nerves (motor).Another example of a cranial nerve reflex is the gag reflex, which involves the glossopharyngeal nerve (sensory) and the vagus nerve (motor). This reflex is important for protecting the airway from foreign objects of substances that may trigger a gag reflex. It is also used as a diagnostic tool to assess the function of these nerves.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 86
Incorrect
-
A young girl who has had herpes encephalitis develops a severe carbohydrate craving and weight gain. What would be your suspicion?
Your Answer:
Correct Answer: Klüver-Bucy syndrome
Explanation:Kluver-Bucy Syndrome: Causes and Symptoms
Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.
The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 87
Incorrect
-
What is the most appropriate term to describe the sequence of events that occurred when a man experienced chest pain at work, was taken to the hospital, received blood tests and an ECG, was prescribed medication, and signed off work for a month by a doctor?
Your Answer:
Correct Answer: Sick role
Explanation:There is no indication of feigning symptoms for personal benefit.
The Sick Role and Illness Behavior
Mechanic and Volkart (1961) introduced the term illness behavior to describe how individuals perceive, evaluate, and respond to symptoms of physical dysfunction. Meanwhile, Talcott Parsons (1951) introduced the concept of the sick role as a temporary form of deviant behavior that is medically sanctioned.
According to Parsons, a sick person experiences conflicting desires to recover from the illness and to enjoy the secondary gains of attention and exemption from normal duties. The sick role is characterized by several rules, including the exemption of the sick person from their normal social roles, which is legitimized by society through the physician. The severity of the illness determines the strength of the exemption.
Additionally, sick persons are not held responsible for their illnesses, as they are beyond personal control. However, they have a duty to try to get well, as sickness is considered undesirable by society. Seeking competent technical help and cooperating with caregivers are also expected of sick persons.
In summary, the sick role and illness behavior are important concepts in understanding how individuals respond to physical dysfunction and how society legitimizes and responds to illness.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 88
Incorrect
-
Which route of administration is known to have the highest degree of first pass effect?
Your Answer:
Correct Answer: Oral
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.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 89
Incorrect
-
Who is considered the foremost advocate of phenomenological psychopathology?
Your Answer:
Correct Answer: Karl Jaspers
Explanation:In the late 19th and early 20th Century, Karl Jaspers was among a group of renowned German psychiatrists based in Heidelberg. His 1913 work, General Psychopathology, was a significant contribution to the field of clinical psychiatry. Meanwhile, Kraepelin advocated for the separation of ‘dementia praecox’ and manic-depression, while Bleuler introduced the term ‘schizophrenia’ to replace dementia praecox.
-
This question is part of the following fields:
- History Of Psychiatry
-
-
Question 90
Incorrect
-
Which of the following diagnostic characteristics is most strongly linked to schizophrenia?
Your Answer:
Correct Answer: Running commentary' hallucinations
Explanation:Somatisation is a clinical feature that can be present in a variety of disorders and is not exclusive to schizophrenia. Delusions of guilt and grandeur are more commonly associated with affective psychosis, while running commentary is a classic symptom of schizophrenia and is given diagnostic significance in ICD-10.
-
This question is part of the following fields:
- Diagnosis
-
-
Question 91
Incorrect
-
Which of the following examples best illustrates a drug interaction that affects the way a drug is absorbed, distributed, metabolized, of eliminated in the body?
Your Answer:
Correct Answer: Change in gastrointestinal tract motility
Explanation:Drug Interactions: Understanding the Different Types
Drug interactions can occur in different ways, and it is important to understand the different types to avoid potential harm. Pharmacokinetic drug interactions happen when one drug affects the metabolism, absorption, of excretion of another drug. This can be due to enzyme induction of inhibition, changes in gastrointestinal tract motility and pH, chelation, competition for renal tubular transport, of changes in protein binding. On the other hand, pharmacodynamic drug interactions occur when one drug directly alters the effect of another drug. This can happen through synergism, antagonism, of interaction at receptors, such as allosteric modulation. It is important to note that pharmacodynamic drug interactions do not involve any absorption, distribution, metabolism, of excretion processes directly. By understanding the different types of drug interactions, healthcare professionals can better manage patients’ medications and prevent potential adverse effects.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 92
Incorrect
-
What is the candidate gene for schizophrenia that is also associated with Velocardiofacial disorder?
Your Answer:
Correct Answer: COMT
Explanation:Schizophrenia is a complex disorder that is associated with multiple candidate genes. No single gene has been identified as the sole cause of schizophrenia, and it is believed that the more genes involved, the greater the risk. Some of the important candidate genes for schizophrenia include DTNBP1, COMT, NRG1, G72, RGS4, DAOA, DISC1, and DRD2. Among these, neuregulin, dysbindin, and DISC1 are the most replicated and plausible genes, with COMT being the strongest candidate gene due to its role in dopamine metabolism. Low activity of the COMT gene has been associated with obsessive-compulsive disorder and schizophrenia. Neuregulin 1 is a growth factor that stimulates neuron development and differentiation, and increased neuregulin signaling in schizophrenia may suppress the NMDA receptor, leading to lowered glutamate levels. Dysbindin is involved in the biogenesis of lysosome-related organelles, and its expression is decreased in schizophrenia. DISC1 encodes a multifunctional protein that influences neuronal development and adult brain function, and it is disrupted in schizophrenia. It is located at the breakpoint of a balanced translocation identified in a large Scottish family with schizophrenia, schizoaffective disorder, and other major mental illnesses.
-
This question is part of the following fields:
- Genetics
-
-
Question 93
Incorrect
-
You are contemplating prescribing a tricyclic antidepressant for an elderly patient who has not shown improvement with two different selective serotonin reuptake inhibitors. Among the following tricyclic antidepressants, which one is the most hazardous in case of overdose?
Your Answer:
Correct Answer: Dosulepin
Explanation:The TCAs that are considered the most hazardous in overdose are amitriptyline and dosulepin (dothiepin).
Tricyclic Antidepressants: Uses, Types, and Side-Effects
Tricyclic antidepressants (TCAs) are a type of medication used for depression and neuropathic pain. However, due to their side-effects and toxicity in overdose, they are not commonly used for depression anymore. TCAs can be divided into two types: first generation (tertiary amines) and second generation (secondary amines). The secondary amines have a lower side effect profile and act primarily on noradrenaline, while the tertiary amines boost serotonin and noradrenaline.
Some examples of secondary amines include desipramine, nortriptyline, protriptyline, and amoxapine. Examples of tertiary amines include amitriptyline, lofepramine, imipramine, clomipramine, dosulepin (dothiepin), doxepin, trimipramine, and butriptyline. Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, and urinary retention.
Low-dose amitriptyline is commonly used for neuropathic pain and prophylaxis of headache. Lofepramine has a lower incidence of toxicity in overdose. However, amitriptyline and dosulepin (dothiepin) are considered the most dangerous in overdose. It is important to consult with a healthcare provider before taking any medication and to follow their instructions carefully.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 94
Incorrect
-
What is the alternate name for the theory that is commonly referred to as the two factor theory?
Your Answer:
Correct Answer: Singer-Schachter theory
Explanation: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.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 95
Incorrect
-
An elevated risk of Ebstein's anomaly has previously been linked to which of the following medications?
Your Answer:
Correct Answer: Lithium
Explanation:The previously assumed higher risk is now uncertain and may not actually exist. We include this question to ensure that you are aware of the past association, as it may still be present in exam materials that have not been revised.
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
-
-
Question 96
Incorrect
-
What is the last stage in Freud's psychosexual development theory?
Your Answer:
Correct Answer: Genital
Explanation:Psychosexual Development
The psychosexual theory of development, developed by Freud, outlines a number of stages that individuals go through in their development. These stages are quite complex, but tend to come up in exams. The stages include the oral stage, which occurs from birth to 18 months, where pleasure and needs are explored through sucking, swallowing, and biting. The anal stage occurs from 18 to 36 months, where pleasure and needs are explored through bowel and bladder elimination and retention. The phallic stage occurs from 3 to 5 years, where boys pass through the Oedipal complex and girls the Electra complex. Girls are also said to develop penis envy in this stage. The latency stage occurs from 5 to puberty, where the sexual drive remains latent. Finally, the genital stage occurs from puberty to adulthood, where a person achieves independence from their parents and forms intimate relationships with others.
-
This question is part of the following fields:
- Psychological Development
-
-
Question 97
Incorrect
-
What is the most effective method for distinguishing between Alzheimer's disease and Lewy body dementia?
Your Answer:
Correct Answer: Dat scan
Explanation:It’s important to note that DaT-SCAN and SPECT are not the same thing. DaT-SCAN specifically refers to the radioactive isotope called Ioflupane, which is utilized in the creation of a SPECT image.
Alzheimer’s disease can be differentiated from healthy older individuals by using SPECT imaging to detect temporal and parietal hypoperfusion, according to studies such as one conducted by W. Jagust in 2001. Additionally, SPECT imaging has proven to be a useful tool in distinguishing between Alzheimer’s disease and Lewy body dementia, as demonstrated in a study by Vaamonde-Gamo in 2005. The image provided shows a SPECT scan of a patient with Alzheimer’s disease compared to one with Lewy body dementia, with the latter showing lower perfusion in the occipital cortex and the former showing lower perfusion in medial temporal areas.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 98
Incorrect
-
Which statement about Fragile X is not true?
Your Answer:
Correct Answer: It only affects males
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.
-
This question is part of the following fields:
- Genetics
-
-
Question 99
Incorrect
-
A Kayser-Fleischer ring is a characteristic sign of which of the following?
Your Answer:
Correct Answer: Wilson's disease
Explanation:Understanding Wilson’s Disease: Causes, Symptoms, and Management
Wilson’s disease, also known as hepatolenticular degeneration, is a genetic disorder that affects copper storage in the body. This condition is caused by a defect in the ATP7B gene, which leads to the accumulation of copper in the liver and brain. The onset of symptoms usually occurs between the ages of 10 and 25, with liver disease being the most common presentation in children and neurological symptoms in young adults.
The excessive deposition of copper in the tissues can cause a range of symptoms, including hepatitis, cirrhosis, basal ganglia degeneration, speech and behavioral problems, asterixis, chorea, dementia, Kayser-Fleischer rings, sunflower cataract, renal tubular acidosis, haemolysis, and blue nails. Diagnosis is based on reduced serum ceruloplasmin, reduced serum copper, and increased 24-hour urinary copper excretion.
The traditional first-line treatment for Wilson’s disease is penicillamine, which chelates copper. Trientine hydrochloride is an alternative chelating agent that may become first-line treatment in the future. Tetrathiomolybdate is a newer agent that is currently under investigation.
In summary, Wilson’s disease is a genetic disorder that affects copper storage in the body, leading to a range of symptoms that can affect the liver, brain, and eyes. Early diagnosis and treatment are essential to prevent complications and improve outcomes.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 100
Incorrect
-
A child presents with symptoms of dyscalculia, dysgraphia, finger agnosia, and right-left disorientation. In which of the following structures would you most expect there to be a lesion?
Your Answer:
Correct Answer: Angular gyrus
Explanation:Gerstmann’s Syndrome: Symptoms and Brain Lesions
Gerstmann’s syndrome is a condition that is characterized by several symptoms, including dyscalculia, dysgraphia, finger agnosia, and right-left disorientation. Patients with this syndrome have been found to have lesions in areas such as the left frontal posterior, left parietal, temporal, and occipital lobes. The left angular gyrus, which is located at the junction of the temporal, occipital, and parietal lobes, seems to be the main area of overlap. Although the function of the angular gyrus is not well understood, it is believed to be involved in various functions such as calculation, spatial reasoning, understanding of ordinal concepts, and comprehension of metaphors.
-
This question is part of the following fields:
- Neurosciences
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)