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  • Question 1 - What factor has been demonstrated to have a notable impact on the QTc...

    Incorrect

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

      Your Answer: Prune juice

      Correct Answer: Grapefruit juice

      Explanation:

      Amantadine and QTc Prolongation

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

    • This question is part of the following fields:

      • Psychopharmacology
      4.8
      Seconds
  • Question 2 - What neuroimaging result is the strongest indicator of new variant CJD? ...

    Correct

    • What neuroimaging result is the strongest indicator of new variant CJD?

      Your Answer: Increased signal in the pulvinar nucleus of thalamus bilaterally

      Explanation:

      Creutzfeldt-Jakob Disease: Differences between vCJD and CJD

      Creutzfeldt-Jakob Disease (CJD) is a prion disease that includes scrapie, BSE, and Kuru. However, there are important differences between sporadic (also known as classic) CJD and variant CJD. The table below summarizes these differences.

      vCJD:
      – Longer duration from onset of symptoms to death (a year of more)
      – Presents with psychiatric and behavioral symptoms before neurological symptoms
      – MRI shows pulvinar sign
      – EEG shows generalized slowing
      – Originates from infected meat products
      – Affects younger people (age 25-30)

      CJD:
      – Shorter duration from onset of symptoms to death (a few months)
      – Presents with neurological symptoms
      – MRI shows bilateral anterior basal ganglia high signal
      – EEG shows biphasic and triphasic waves 1-2 per second
      – Originates from genetic mutation (bad luck)
      – Affects older people (age 55-65)

      Overall, understanding the differences between vCJD and CJD is important for diagnosis and treatment.

    • This question is part of the following fields:

      • Neurosciences
      10.5
      Seconds
  • Question 3 - Who is the individual that put forth a theory regarding cognitive development? ...

    Correct

    • Who is the individual that put forth a theory regarding cognitive development?

      Your Answer: Piaget

      Explanation:

      Developmental Stages

      There are four main developmental models that are important to understand: Freud’s theory of psychosexual development, Erikson’s theory of psychosocial development, Piaget’s theory of cognitive development, and Kohlberg’s theory of moral development.

      Freud’s theory of psychosexual development includes five stages: oral, anal, phallic, latency, and genital. These stages occur from birth to adulthood and are characterized by different areas of focus and pleasure.

      Erikson’s theory of psychosocial development includes eight stages, each with a specific crisis to be resolved. These stages occur from infancy to old age and are focused on developing a sense of self and relationships with others.

      Piaget’s theory of cognitive development includes four stages: sensorimotor, preoperational, concrete operational, and formal operational. These stages occur from birth to adulthood and are focused on the development of cognitive abilities such as perception, memory, and problem-solving.

      Kohlberg’s theory of moral development includes three stages: preconventional, conventional, and postconventional. These stages occur from childhood to adulthood and are focused on the development of moral reasoning and decision-making.

      Understanding these developmental models can help individuals better understand themselves and others, as well as provide insight into how to support healthy development at each stage.

    • This question is part of the following fields:

      • Psychological Development
      6.7
      Seconds
  • Question 4 - Which of the options below does not belong to the category of small...

    Correct

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

      Your Answer: Prolactin

      Explanation:

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

    • This question is part of the following fields:

      • Neurosciences
      9.3
      Seconds
  • Question 5 - QTc prolongation is associated with which of the following metabolic changes? ...

    Correct

    • QTc prolongation is associated with which of the following metabolic changes?

      Your Answer: Hypomagnesaemia

      Explanation:

      Amantadine and QTc Prolongation

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

    • This question is part of the following fields:

      • Psychopharmacology
      9.1
      Seconds
  • Question 6 - What kind of hallucination is it when a man hears a woman scream...

    Correct

    • What kind of hallucination is it when a man hears a woman scream every time the light turns on?

      Your Answer: Reflex

      Explanation:

      Functional refers to the use of the same type of sensory input.

      Altered Perceptual Experiences

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

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

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

    • This question is part of the following fields:

      • Classification And Assessment
      5.6
      Seconds
  • Question 7 - What is a frequently observed side effect of carbamazepine? ...

    Correct

    • What is a frequently observed side effect of carbamazepine?

      Your Answer: Ataxia

      Explanation:

      The use of carbamazepine often results in numerous side effects, with ataxia being a common occurrence.

      Carbamazepine: Uses, Mechanism of Action, Contraindications, Warnings, and Side-Effects

      Carbamazepine, also known as Tegretol, is a medication commonly used in the treatment of epilepsy, particularly partial seizures. It is also used for neuropathic pain, bipolar disorder, and other conditions. The drug works by binding to sodium channels and increasing their refractory period.

      However, carbamazepine has notable contraindications, including a history of bone marrow depression and combination with monoamine oxidase inhibitors (MAOIs). It also carries warnings for serious dermatological reactions such as toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome.

      Common side-effects of carbamazepine include leucopenia, ataxia, dizziness, somnolence, vomiting, nausea, urticaria, and fatigue. Other side-effects include thrombocytopenia, eosinophilia, oedema, fluid retention, weight increase, hyponatraemia, and blood osmolarity decreased due to an antidiuretic hormone (ADH)-like effect, leading in rare cases to water intoxication accompanied by lethargy, vomiting, headache, confusional state, neurological disorders, diplopia, accommodation disorders (e.g. blurred vision), and dry mouth.

      In summary, carbamazepine is a medication with multiple uses, but it also carries significant contraindications, warnings, and side-effects that should be carefully considered before use.

    • This question is part of the following fields:

      • Psychopharmacology
      4.7
      Seconds
  • Question 8 - In 1927, which illness did Julius Wagner-Jauregg receive recognition for in becoming the...

    Incorrect

    • In 1927, which illness did Julius Wagner-Jauregg receive recognition for in becoming the first psychiatrist to be awarded a Nobel prize for medicine?

      Your Answer: Neurasthenia

      Correct Answer: General paresis of the insane

      Explanation:

      In 1917, Wagner-Jauregg created a successful cure for general paresis of the insane (GPI), a type of neurosyphilis. The treatment involved infecting patients with malaria parasites, which induced a long-lasting fever (known as pyrotherapy) and resulted in noticeable improvement. Any subsequent malaria infections were then treated with quinine, which was readily accessible at the time.

    • This question is part of the following fields:

      • History Of Psychiatry
      13.1
      Seconds
  • Question 9 - What is the likelihood of a child developing schizophrenia if one of their...

    Correct

    • What is the likelihood of a child developing schizophrenia if one of their parents has the condition, based on the Gottesman data?

      Your Answer: 13%

      Explanation:

      Schizophrenia Risk According to Gottesman

      Irving I. Gottesman conducted family and twin studies in European populations between 1920 and 1987 to determine the risk of developing schizophrenia for relatives of those with the disorder. The following table displays Gottesman’s findings, which show the average lifetime risk for each relationship:

      General population: 1%
      First cousin: 2%
      Uncle/aunt: 2%
      Nephew/niece: 4%
      Grandchildren: 5%
      Parents: 6%
      Half sibling: 6%
      Full sibling: 9%
      Children: 13%
      Fraternal twins: 17%
      Offspring of dual matings (both parents had schizophrenia): 46%
      Identical twins: 48%

    • This question is part of the following fields:

      • Genetics
      5.4
      Seconds
  • Question 10 - At what age does stranger anxiety usually develop? ...

    Correct

    • At what age does stranger anxiety usually develop?

      Your Answer: 8 months

      Explanation:

      Attachment Theory and Harlow’s Monkeys

      Attachment theory, developed by John Bowlby, suggests that children have an innate tendency to form relationships with people around them to increase their chance of survival. This attachment is different from bonding, which concerns the mother’s feelings for her infant. Children typically single out a primary caregiver, referred to as the principle attachment figure, from about 1-3 months. The quality of a person’s early attachments is associated with their adult behavior, with poor attachments leading to withdrawn individuals who struggle to form relationships and good attachments leading to socially competent adults who can form healthy relationships.

      Bowlby’s attachment model has four stages: preattachment, attachment in the making, clear-cut attachment, and formation of reciprocal attachment. The time from 6 months to 36 months is known as the critical period, during which a child is most vulnerable to interruptions in its attachment. Attachments are divided into secure and insecure types, with insecure types further divided into avoidant and ambivalent types.

      Harlow’s experiment with young rhesus monkeys demonstrated the importance of the need for closeness over food. The experiment involved giving the monkeys a choice between two different mothers, one made of soft terry cloth but provided no food and the other made of wire but provided food from an attached baby bottle. The baby monkeys spent significantly more time with their cloth mother than with their wire mother, showing the importance of attachment and closeness in early development.

    • This question is part of the following fields:

      • Psychological Development
      3.6
      Seconds
  • Question 11 - What strategies can be used to distinguish between normal grief and major depression?...

    Correct

    • What strategies can be used to distinguish between normal grief and major depression?

      Your Answer: Generalised guilt

      Explanation:

      Understanding Grief: Normal and Abnormal Phases

      Grief is a natural response to loss, and it is a complex process that can take different forms and durations. John Bowlby and Kubler-Ross have proposed models to describe the typical phases of grief, which can vary in intensity and duration for each individual. Bowlby’s model includes shock-numbness, yearning-searching, disorganization-despair, and reorganization, while Kubler-Ross’s model includes denial-dissociation-isolation, anger, bargaining, depression, and acceptance.

      However, some people may experience abnormal grief, which can be categorized as inhibited, delayed, of chronic/prolonged. Inhibited grief refers to the absence of expected grief symptoms at any stage, while delayed grief involves avoiding painful symptoms within two weeks of loss. Chronic/prolonged grief is characterized by continued significant grief-related symptoms six months after loss.

      It is important to distinguish between normal grief and major depression, as a high proportion of people may meet the criteria for major depression in the first year following bereavement. Some features that can help differentiate between the two include generalized guilt, thoughts of death unrelated to the deceased, feelings of worthlessness, psychomotor retardation, and prolonged functional impairment.

      Overall, understanding the phases and types of grief can help individuals and their loved ones navigate the grieving process and seek appropriate support and resources.

    • This question is part of the following fields:

      • Social Psychology
      8.3
      Seconds
  • Question 12 - What is the enzyme that shows increased levels in Neuroleptic malignant syndrome? ...

    Correct

    • What is the enzyme that shows increased levels in Neuroleptic malignant syndrome?

      Your Answer: CPK

      Explanation:

      Elevated levels of creatine phosphokinase (CPK) are observed in NMS.

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

    • This question is part of the following fields:

      • Psychopharmacology
      4.7
      Seconds
  • Question 13 - In which region of the CNS do serotonergic neurons have the highest concentration...

    Incorrect

    • In which region of the CNS do serotonergic neurons have the highest concentration of cell bodies?

      Your Answer: Enterochromaffin cells

      Correct Answer: Raphe nuclei

      Explanation:

      The raphe nuclei in the brainstem are the primary location of serotonergic neuronal cell bodies in the central nervous system (CNS), which project to the brain and spinal cord. Noradrenaline is synthesised by the locus coeruleus, located in the pons. Dopamine is produced in the substantia nigra and ventral tegmental area in the midbrain. While the majority of serotonin is found in enterochromaffin cells in the gastrointestinal (GI) tract, this is not considered part of the CNS. These neurotransmitters play important roles in various physiological and psychological processes.

    • This question is part of the following fields:

      • Neurosciences
      11.2
      Seconds
  • Question 14 - Which type of dementia is characterized by the presence of clumps of aggregated...

    Correct

    • Which type of dementia is characterized by the presence of clumps of aggregated alpha synuclein in the cell bodies and axons of neurons?

      Your Answer: Lewy body dementia

      Explanation:

      Alpha-synuclein is the main component of Lewy bodies, which are inclusion bodies found in the cytoplasm of neurons and appear eosinophilic.

      Lewy body dementia is a neurodegenerative disorder that is characterized by both macroscopic and microscopic changes in the brain. Macroscopically, there is cerebral atrophy, but it is less marked than in Alzheimer’s disease, and the brain weight is usually in the normal range. There is also pallor of the substantia nigra and the locus coeruleus, which are regions of the brain that produce dopamine and norepinephrine, respectively.

      Microscopically, Lewy body dementia is characterized by the presence of intracellular protein accumulations called Lewy bodies. The major component of a Lewy body is alpha synuclein, and as they grow, they start to draw in other proteins such as ubiquitin. Lewy bodies are also found in Alzheimer’s disease, but they tend to be in the amygdala. They can also be found in healthy individuals, although it has been suggested that these may be pre-clinical cases of dementia with Lewy bodies. Lewy bodies are also found in other neurodegenerative disorders such as progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy.

      In Lewy body dementia, Lewy bodies are mainly found within the brainstem, but they are also found in non-brainstem regions such as the amygdaloid nucleus, parahippocampal gyrus, cingulate cortex, and cerebral neocortex. Classic brainstem Lewy bodies are spherical intraneuronal cytoplasmic inclusions, characterized by hyaline eosinophilic cores, concentric lamellar bands, narrow pale halos, and immunoreactivity for alpha synuclein and ubiquitin. In contrast, cortical Lewy bodies typically lack a halo.

      Most brains with Lewy body dementia also show some plaques and tangles, although in most instances, the lesions are not nearly as severe as in Alzheimer’s disease. Neuronal loss and gliosis are usually restricted to brainstem regions, particularly the substantia nigra and locus ceruleus.

    • This question is part of the following fields:

      • Neurosciences
      12.7
      Seconds
  • Question 15 - What is a true statement about evaluating obesity? ...

    Incorrect

    • What is a true statement about evaluating obesity?

      Your Answer: A waist circumference of 86 cm in an adult female is considered high

      Correct Answer: A waist circumference of 100 cm in an adult male is considered normal

      Explanation:

      Assessment and Management of Obesity

      Obesity is a condition that can increase the risk of various health problems, including type 2 diabetes, coronary heart disease, some types of cancer, and stroke. The body mass index (BMI) is a commonly used tool to assess obesity, calculated by dividing a person’s weight in kilograms by their height in meters squared. For adults over 20 years old, BMI falls into one of the following categories: underweight, normal of healthy weight, pre-obesity/overweight, obesity class I, obesity class II, and obesity class III.

      Waist circumference can also be used in combination with BMI to guide interventions. Diet and exercise are the main interventions up to a BMI of 35, unless there are comorbidities such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidemia, and sleep apnea. Physical activity recommendations suggest that adults should accumulate at least 150 minutes of moderate intensity activity of 75 minutes of vigorous intensity activity per week. Dietary recommendations suggest diets that have a 600 kcal/day deficit.

      Pharmacological options such as Orlistat of Liraglutide may be considered for those with a BMI of 30 kg/m2 of more, of 28 if associated risk factors. Surgical options such as bariatric surgery may be considered for those with a BMI of 40 kg/m2 of more, of between 35 kg/m2 and 40 kg/m2 with other significant diseases that could be improved with weight loss.

    • This question is part of the following fields:

      • Classification And Assessment
      20.9
      Seconds
  • Question 16 - What was the initial formal thought disorder feature that Kurt Schneider identified? ...

    Incorrect

    • What was the initial formal thought disorder feature that Kurt Schneider identified?

      Your Answer: Asyndesis

      Correct Answer: Omission

      Explanation:

      Kurt Schneider identified five characteristics of formal thought disorders, which include substitution, omission, fusion, drivelling, and derailment. Omission refers to the tendency for individuals to leave out certain thoughts of parts of their thoughts during conversations, without realizing it. On the other hand, Cameron described additional features of formal thought disorders, such as asyndesis, interpenetration, metonymy, and overinclusion. For more information on this topic, interested readers may refer to the Textbook of Psychiatry, 3rd edition, by Puri BK and Treasaden IH.

    • This question is part of the following fields:

      • History Of Psychiatry
      13.6
      Seconds
  • Question 17 - Based on the information provided, it is most likely that the 25-year-old male...

    Correct

    • Based on the information provided, it is most likely that the 25-year-old male with schizophrenia, who has no significant medical history, is experiencing symptoms of dehydration and hypoglycemia due to excessive fluid intake and lack of food intake. He has become lethargic and is vomiting, which are common symptoms of dehydration. His low blood glucose level of 4.3 mmol/L indicates that he has not eaten in a while and is experiencing hypoglycemia. It is important to address his dehydration and hypoglycemia promptly to prevent further complications.

      Your Answer: Psychogenic polydipsia

      Explanation:

      It is probable that the patient is experiencing hyponatremia due to psychogenic polydipsia, while diabetes mellitus can be ruled out as their blood glucose level is normal. Additionally, lithium toxicity is an unlikely cause as lithium is not typically prescribed for schizophrenia treatment.

      Psychogenic polydipsia is a condition where there is excessive consumption of fluids leading to polyuria, and it is commonly seen in psychiatric conditions such as schizophrenia and developmental disorders. The exact mechanism is unknown, but it is thought to be due to a defect in thirst and a dysfunction in AVP regulation. Patients with psychogenic polydipsia rarely complain of thirst but instead provide delusional explanations for their excessive drinking of state that drinking reduces their anxiety and makes them feel better. If fluid intake exceeds the capacity for excretion, then the resultant hyponatremia may produce signs of water intoxication. It is best managed by fluid restriction. Differential diagnosis should be done to rule out other causes of polyuria and polydipsia. Investigations such as fluid balance charts, urine dipstick, serum U&E and calcium, and urine and plasma osmolality should be arranged. Primary polydipsia can be subclassified into psychogenic and dipsogenic types.

    • This question is part of the following fields:

      • Classification And Assessment
      26.6
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  • Question 18 - What is an example of a type of passive thinking? ...

    Correct

    • What is an example of a type of passive thinking?

      Your Answer: Thought broadcast

      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
      6.9
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  • Question 19 - For which condition is the Addenbrooke's exam (ACE-III) most beneficial in evaluating? ...

    Correct

    • For which condition is the Addenbrooke's exam (ACE-III) most beneficial in evaluating?

      Your Answer: Dementia

      Explanation:

      The Addenbrooke’s Cognitive Exam: A Brief Screening Tool for Dementia

      The Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool developed to detect dementia and differentiate Alzheimer’s dementia from frontotemporal dementia. It was created to address the limitations of the MMSE, which lacked sensitivity for frontal-executive dysfunction and visuospatial defects. The ACE is a brief test that takes 15-20 minutes to administer and is divided into five domains: attention and orientation, memory, verbal fluency, language, and visuospatial abilities. The total score is based on a maximum score of 100, with higher scores indicating better cognitive functioning.

      The ACE has been shown to be a valid tool for detecting dementia, with two cut-off points often used depending on the required sensitivity and specificity. A score of less than 88 has 100% sensitivity for detecting dementia, while a score of less than 82 has 93% sensitivity and 100% specificity. It has also been useful in differentiating dementia from pseudo dementia and detecting cognitive impairment in atypical Parkinson syndromes. However, while the test has shown 100% sensitivity and specificity in studies, its performance may vary in clinical practice.

    • This question is part of the following fields:

      • Classification And Assessment
      3.9
      Seconds
  • Question 20 - If budget constraints were the only consideration in allocating healthcare resources, what ethical...

    Correct

    • If budget constraints were the only consideration in allocating healthcare resources, what ethical framework would guide the decision-making process?

      Your Answer: Utilitarian

      Explanation:

      While quality adjusted life years (QALY) are a utilitarian measure, it would be extreme to suggest that individuals with illnesses that require expensive treatments should not be treated solely based on the cost-benefit analysis. The general population does not strictly adhere to utilitarian principles, and therefore, The National Institute for Health and Care Excellence (NICE) considers other factors such as justice and the availability of alternative treatments for a particular condition in addition to the cost per QALY when making recommendations.

    • This question is part of the following fields:

      • Basic Ethics And Philosophy Of Psychiatry
      9.1
      Seconds
  • Question 21 - A 25-year-old woman who has recently moved to the United States from Japan...

    Correct

    • A 25-year-old woman who has recently moved to the United States from Japan presents to the local Emergency department in a state of extreme anxiety. The attending physician refers her to you as the psychiatrist on call and reports no evidence of an organic illness based on her physical examination.

      Upon meeting the patient, she expresses intense distress and reports a belief that her vagina is shrinking and that she will die as a result. She attributes this to a loss of balance in her sexual energy after engaging in sexual activity with a partner who did not align with her astrological sign.

      What would be your preferred diagnosis?

      Your Answer: Koro

      Explanation:

      The symptoms exhibited by the patient are consistent with Koro, a culture-specific disorder observed primarily in males (and occasionally in females) in China and Thailand. For more information, please refer to Edwards JW’s article Indigenous Koro, a genital retraction syndrome of insular Southeast Asia: a critical review published in Cult Med Psychiatry in 1984.

    • This question is part of the following fields:

      • Social Psychology
      17.8
      Seconds
  • Question 22 - A physician declines to administer clozapine to a middle-aged man with treatment-resistant schizophrenia...

    Correct

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

      Your Answer: Non-maleficence

      Explanation:

      Healthcare Ethics and Conflicting Principles

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

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

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

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

    • This question is part of the following fields:

      • Basic Ethics And Philosophy Of Psychiatry
      13.3
      Seconds
  • Question 23 - A client in their 60s presents with insomnia and requires short term night...

    Correct

    • A client in their 60s presents with insomnia and requires short term night sedation. They have an early morning commute and need to drive to work at 6:30 am. Considering the half-life, what would be the most suitable option?

      Your Answer: Zolpidem

      Explanation:

      Benzodiazepines are a class of drugs commonly used to treat anxiety and sleep disorders. It is important to have a working knowledge of the more common benzodiazepines and their half-life. Half-life refers to the amount of time it takes for half of the drug to be eliminated from the body.

      Some of the more common benzodiazepines and their half-life include diazepam with a half-life of 20-100 hours, clonazepam with a half-life of 18-50 hours, chlordiazepoxide with a half-life of 5-30 hours, nitrazepam with a half-life of 15-38 hours, temazepam with a half-life of 8-22 hours, lorazepam with a half-life of 10-20 hours, alprazolam with a half-life of 10-15 hours, oxazepam with a half-life of 6-10 hours, zopiclone with a half-life of 5-6 hours, zolpidem with a half-life of 2 hours, and zaleplon with a half-life of 2 hours. Understanding the half-life of these drugs is important for determining dosages and timing of administration.

    • This question is part of the following fields:

      • Psychopharmacology
      18.1
      Seconds
  • Question 24 - In comparison to which method of administration, is bioavailability defined as the proportion...

    Correct

    • 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: 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
      9.5
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  • Question 25 - What is the life event that Holmes and Rahe consider to be the...

    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 – 45

      This 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
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      Seconds
  • Question 26 - Based on the ECA study, what factors are associated with an increased probability...

    Correct

    • Based on the ECA study, what factors are associated with an increased probability of receiving psychiatric treatment?

      Your Answer: City residence

      Explanation:

      Factors Predicting Likelihood of Receiving Psychiatric Treatment

      Several factors have been identified as predictors of a higher likelihood of receiving psychiatric treatment. These include living in a city, being divorced or separated, having access to geographically accessible services, belonging to a higher social class, being male, and being a young adult. Interestingly, despite the fact that many psychiatric disorders are more prevalent in lower social classes, individuals from higher social classes are more likely to receive psychiatric treatment. On the other hand, factors such as living in rural areas, being married, lacking access to services, belonging to a lower social class, being female, and being an older adult are associated with a lower likelihood of receiving psychiatric treatment.

    • This question is part of the following fields:

      • Epidemiology
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  • Question 27 - In which type of condition of disease are Hirano bodies typically observed? ...

    Correct

    • In which type of condition of disease are Hirano bodies typically observed?

      Your Answer: Alzheimer's

      Explanation:

      Hirano bodies are a nonspecific indication of neurodegeneration and are primarily observed in.

      Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.

    • This question is part of the following fields:

      • Neurosciences
      5.2
      Seconds
  • Question 28 - What is the annual incidence rate of tardive dyskinesia in patients exposed to...

    Correct

    • What is the annual incidence rate of tardive dyskinesia in patients exposed to typical antipsychotics?

      Your Answer: 5%

      Explanation:

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

    • This question is part of the following fields:

      • Psychopharmacology
      3.2
      Seconds
  • Question 29 - What is the probable diagnosis for an adult physicist who avoids teaching and...

    Incorrect

    • What is the probable diagnosis for an adult physicist who avoids teaching and publishing, is known for walking barefoot and dressing casually, and prefers solitude over socializing with colleagues and students?

      Your Answer: Schizotypal personality disorder

      Correct Answer: Schizoid personality disorder

      Explanation:

      Schizoid personality disorder is a personality disorder that is only recognized in the ICD-10. It is characterized by a lack of enjoyment in activities, emotional detachment, difficulty expressing emotions, indifference to praise of criticism, little interest in sexual experiences, a preference for solitary activities, excessive introspection, a lack of close relationships, and insensitivity to social norms. When diagnosing this disorder, it is important to differentiate it from an autistic spectrum disorder. One way to do this is to look for a lack of reliance on routines and rituals, as well as a lack of desire for friendship of relationships. While individuals with an autistic spectrum disorder may struggle with relationships, they typically desire them and experience feelings of loneliness.

    • This question is part of the following fields:

      • Diagnosis
      12.8
      Seconds
  • Question 30 - Which statement accurately describes the placebo effect? ...

    Correct

    • Which statement accurately describes the placebo effect?

      Your Answer: Placebo response tends to be greater in milder forms of illness

      Explanation:

      Understanding the Placebo Effect

      In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.

      Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.

      The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.

      It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 31 - When is the optimal time to collect blood samples for monitoring therapeutic lithium...

    Correct

    • When is the optimal time to collect blood samples for monitoring therapeutic lithium levels?

      Your Answer: 12 hours after last dose

      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
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  • Question 32 - A 72-year-old male is experiencing depression after being admitted for a flare-up of...

    Correct

    • A 72-year-old male is experiencing depression after being admitted for a flare-up of chronic obstructive pulmonary disease. Which antidepressant would be the most suitable to initiate?

      Your Answer: Fluoxetine

      Explanation:

      Unless there is a specific reason stated in the vignette, the first-line treatment for depression with medication is typically a selective serotonin reuptake inhibitor (SSRI). However, an alternative option may be duloxetine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI).

      SSRIs, of selective serotonin reuptake inhibitors, are the first-line treatment for depression in most patients. However, some SSRIs have different side effects and interactions than others. For example, fluoxetine, fluvoxamine, and paroxetine have a higher propensity for drug interactions, while citalopram is useful for elderly patients as it is associated with lower risks of drug interactions. SSRIs should be used with caution in children and adolescents, and fluoxetine is the drug of choice in this population.

      Common side effects of SSRIs include gastrointestinal symptoms, sedation, and sexual dysfunction. Paroxetine is considered the most sedating and anticholinergic, while vortioxetine is associated with the least sexual dysfunction. Patients taking SSRIs are at an increased risk of gastrointestinal bleeding, and a proton pump inhibitor should be prescribed if they are also taking an NSAID.

      When stopping a SSRI, the dose should be gradually reduced over a 4 week period, except for fluoxetine. Paroxetine has a higher incidence of discontinuation symptoms, which can include mood changes, restlessness, difficulty sleeping, and gastrointestinal symptoms.

      SSRIs can also have interactions with other medications, such as NSAIDs, warfarin/heparin, aspirin, and triptans. Patients should be reviewed by a doctor after starting antidepressant therapy, and if they make a good response, they should continue treatment for at least 6 months after remission to reduce the risk of relapse.

      In patients who have had a myocardial infarction, approximately 20% develop depression. SSRIs are the preferred antidepressant group post-MI, but they can increase the bleeding risk, especially in those using anticoagulation. Mirtazapine is an alternative option, but it too is associated with bleeding. The SADHART study found sertraline to be a safe treatment for depression post-myocardial infarction.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 33 - A client is referred to your clinic by their physician due to a...

    Correct

    • A client is referred to your clinic by their physician due to a recent decline in their mood. The client reports difficulty swallowing pills and shares that during their last visit with a psychiatrist, they were given an antidepressant in the form of a patch. Can you identify which antidepressant was previously prescribed to this client?

      Your Answer: Selegiline

      Explanation:

      Alternative Routes of Administration for Antidepressants

      While most antidepressants are taken orally, there are a few alternative routes of administration available. However, it is important to note that these non-oral preparations should only be used when absolutely necessary, as they may not have a UK licence.

      One effective alternative route is sublingual administration of fluoxetine liquid. Buccal administration of selegiline is also available. Crushed amitriptyline has been shown to be effective when administered via this route.

      Intravenous administration is another option, with several antidepressants available in IV preparations, including citalopram, escitalopram, mirtazapine, amitriptyline, clomipramine, and allopregnanolone (which is licensed in the US for postpartum depression). Ketamine has also been shown to be effective when administered intravenously.

      Intramuscular administration of flupentixol has been shown to have a mood elevating effect, but amitriptyline was discontinued as an IM preparation due to the high volumes required.

      Transdermal administration of selegiline is available, and suppositories containing amitriptyline, clomipramine, imipramine, and trazodone have been manufactured by pharmacies, although there is no clear data on their effectiveness. Sertraline tablets and doxepin capsules have also been given rectally.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 34 - Which of the following options correctly orders the phases of mitosis? ...

    Correct

    • Which of the following options correctly orders the phases of mitosis?

      Your Answer: Prophase, Prometaphase, Metaphase, Anaphase, Telophase, Cytokinesis

      Explanation:

      Cytokinesis: The Final Stage of Cell Division

      Cytokinesis is the final stage of cell division, where the cell splits into two daughter cells, each with a nucleus. This process is essential for the growth and repair of tissues in multicellular organisms. In mitosis, cytokinesis occurs after telophase, while in meiosis, it occurs after telophase I and telophase II.

      During cytokinesis, a contractile ring made of actin and myosin filaments forms around the cell’s equator, constricting it like a belt. This ring gradually tightens, pulling the cell membrane inward and creating a furrow that deepens until it reaches the center of the cell. Eventually, the furrow meets in the middle, dividing the cell into two daughter cells.

      In animal cells, cytokinesis is achieved by the formation of a cleavage furrow, while in plant cells, a cell plate forms between the two daughter nuclei, which eventually develops into a new cell wall. The timing and mechanism of cytokinesis are tightly regulated by a complex network of proteins and signaling pathways, ensuring that each daughter cell receives the correct amount of cytoplasm and organelles.

      Overall, cytokinesis is a crucial step in the cell cycle, ensuring that genetic material is equally distributed between daughter cells and allowing for the growth and development of multicellular organisms.

    • This question is part of the following fields:

      • Genetics
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      Seconds
  • Question 35 - What are the two purine bases? ...

    Incorrect

    • What are the two purine bases?

      Your Answer: Thymine and cytosine

      Correct Answer: Adenine and guanine

      Explanation:

      Nucleotides: The Building Blocks of DNA and RNA

      Nucleotides are the fundamental units of DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). Each nucleotide consists of three components: a sugar molecule (deoxyribose in DNA and ribose in RNA), a phosphate group, and a nitrogenous base. The nitrogenous bases can be classified into two categories: purines and pyrimidines. The purine bases include adenine and guanine, while the pyrimidine bases are cytosine, thymine (in DNA), and uracil (in RNA).

      The arrangement of nucleotides in DNA and RNA determines the genetic information that is passed from one generation to the next. The sequence of nitrogenous bases in DNA forms the genetic code that determines the traits of an organism. RNA, on the other hand, plays a crucial role in protein synthesis by carrying the genetic information from DNA to the ribosomes, where proteins are synthesized.

      Understanding the structure and function of nucleotides is essential for understanding the molecular basis of life. The discovery of the structure of DNA and the role of nucleotides in genetic information has revolutionized the field of biology and has led to many breakthroughs in medicine, biotechnology, and genetics.

    • This question is part of the following fields:

      • Genetics
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  • Question 36 - A 30-year-old African American woman visits her primary care physician with complaints of...

    Incorrect

    • A 30-year-old African American woman visits her primary care physician with complaints of excessive fatigue and weakness. She is convinced that she is experiencing urinary incontinence and requests a referral to a specialist. Medical tests show no evidence of any underlying physical conditions. What is the most probable diagnosis?

      Your Answer: Hyperschemazia

      Correct Answer: Dhat syndrome

      Explanation:

      Dhat syndrome is a condition commonly observed in the Indian subcontinent, characterized by fatigue and weakness, and the belief that one is expelling semen in their urine. The condition has no identifiable physical cause.

      Hyperschemazia is a condition where individuals perceive certain body parts as being larger than they actually are.

      Koro is a belief, typically found in Southeast Asia, that the penis is shrinking and will eventually retract into the abdomen, leading to death. This belief is thought to stem from a misunderstanding of anatomy.

      Latah is a condition similar to Tourette’s syndrome, where individuals exhibit abnormal behavior in response to exaggerated startle responses. This may include screaming, cursing, dancing movements, uncontrollable laughter, and obeying commands they would not normally follow.

      Nihilistic delusion is characterized by a strong sense of self-negation, where individuals may believe that they are dead of that their internal organs are decaying.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 37 - Who is the author of 'The Psychopathology of Everyday Life'? ...

    Correct

    • Who is the author of 'The Psychopathology of Everyday Life'?

      Your Answer: Sigmund Freud

      Explanation:

      History of major works in psychiatry
      Michel Foucault – Madness and civilization
      Sigmund Freud – The interpretation of dreams, Beyond the Pleasure Principle, The Psychopathology of everyday life
      Thomas Szasz – The myth of mental illness
      Erving Goffman – Asylums, The Presentation of Self in Everyday Life
      Ronald Laing – The divided self
      Emile Durkheim – Le suicide. Durkheim proposed social causes for suicide. Until his work was published, suicide had been thought of as an individual act only.
      Tom Main – The Ailment
      Jerome Frank – Persuasion and Healing
      George Brown and Tirril Harris – Social origins of depression

    • This question is part of the following fields:

      • Social Psychology
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      Seconds
  • Question 38 - A consultant pediatrician attends the clinic for an interview with a young patient....

    Correct

    • A consultant pediatrician attends the clinic for an interview with a young patient. The child had been very restless until she arrived but settled down immediately in fear that the doctor might decide to give her a shot. This is an example of which of the following?

      Your Answer: Hawthorne effect

      Explanation:

      The Hawthorne effect is a type of bias that occurs when individuals alter their behavior because they believe they are being observed. The halo effect is a cognitive bias where one’s perception of a trait is influenced by their perception of another trait, such as assuming someone with glasses is intelligent. The Forer effect explains why people give high accuracy ratings to personality descriptions that are actually vague and general enough to apply to many people, as seen in practices like astrology. The interloper effect is the tendency to view third-party consultation as objective. The practice effect refers to the impact of past experience on taking a test again, resulting in higher scores, especially when the interval between tests is short.

      The Hawthorne Effect and Its Impact on Research

      The Hawthorne effect is a type of observer bias that occurs when individuals modify their behavior because they believe they are being observed. This phenomenon can have a significant impact on research outcomes, as subjects may alter their actions of responses in an attempt to please the observer of researcher. For instance, if a person knows they are being watched while performing a task, they may complete it more quickly of with greater accuracy than they would otherwise. As a result, researchers must be aware of the Hawthorne effect and take steps to minimize its influence on their studies. Failure to do so can lead to inaccurate of misleading results, which can have serious consequences for the validity of the research.

    • This question is part of the following fields:

      • Social Psychology
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      Seconds
  • Question 39 - A researcher studying suicide prevention strategies in elderly populations is gathering information on...

    Correct

    • 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: 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
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  • Question 40 - Which option is the least appropriate for nighttime sedation? ...

    Correct

    • Which option is the least appropriate for nighttime sedation?

      Your Answer: Diazepam

      Explanation:

      It is advisable to avoid agents with longer half lives as they have a tendency to induce drowsiness in patients.

      Benzodiazepines are a class of drugs commonly used to treat anxiety and sleep disorders. It is important to have a working knowledge of the more common benzodiazepines and their half-life. Half-life refers to the amount of time it takes for half of the drug to be eliminated from the body.

      Some of the more common benzodiazepines and their half-life include diazepam with a half-life of 20-100 hours, clonazepam with a half-life of 18-50 hours, chlordiazepoxide with a half-life of 5-30 hours, nitrazepam with a half-life of 15-38 hours, temazepam with a half-life of 8-22 hours, lorazepam with a half-life of 10-20 hours, alprazolam with a half-life of 10-15 hours, oxazepam with a half-life of 6-10 hours, zopiclone with a half-life of 5-6 hours, zolpidem with a half-life of 2 hours, and zaleplon with a half-life of 2 hours. Understanding the half-life of these drugs is important for determining dosages and timing of administration.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 41 - A 50-year-old male patient is admitted to your inpatient ward after intentionally overdosing...

    Correct

    • A 50-year-old male patient is admitted to your inpatient ward after intentionally overdosing on his newly prescribed interferon medication for a neurological condition. During your physical assessment, you shine a penlight into his right eye and observe both pupils constricting. However, shining the light into his left eye does not elicit a response.
      Which cranial nerve may be affected by this observation?

      Your Answer: II

      Explanation:

      The pupils are innervated by both sides of the midbrain and respond to ambient light levels. If there is an optic nerve lesion, the non-damaged nerve becomes dominant and both pupils respond to ambient light from that nerve. A helpful mnemonic for remembering the cranial nerves and their functions is OOOTTAFVGVAH for the nerves and SSMMBMBSBBMM for their functions. To recall the innervation of the extraocular muscles, one can use SO4 LR6. The optic nerve is II, oculomotor is III and supplies all extraocular muscles except for the superior oblique and lateral rectus, trochlear is IV and innervates the superior oblique muscle for depression and intorsion, trigeminal is V and supplies sensory information and muscles of mastication, and abducens is VI and controls the lateral rectus muscle of the eye.

    • This question is part of the following fields:

      • Neurological Examination
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  • Question 42 - Whose studies on attachment with primates showed that comfort and affection were prioritized...

    Correct

    • Whose studies on attachment with primates showed that comfort and affection were prioritized over nourishment and sustenance?

      Your Answer: Harlow

      Explanation:

      Harry Harlow conducted controversial experiments with rhesus macaque monkeys and surrogate ‘mothers’ made of inanimate objects, revealing that the infants preferred comfort and warmth over food.
      Mary Ainsworth created the Strange Situation classification to categorize infants’ attachment behaviors.
      John Bowlby coined the term ‘attachment’ to describe a child’s bond with their mother.
      Konrad Lorenz studied imprinting in geese that were hatched in incubators.
      Mary Main played a role in the development of the Adult Attachment Interview, which evaluates an individual’s early attachment experiences.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 43 - What is the term for the hallucinations that occur when someone is about...

    Correct

    • What is the term for the hallucinations that occur when someone is about to fall asleep?

      Your Answer: Hypnagogic hallucinations

      Explanation:

      Hallucinations that occur when falling asleep are called hypnagogic and are typically short and basic, such as simple sounds of flashes of light. Non-complex hallucinations, like sudden noises of brief flashes, are referred to as elementary hallucinations and can happen at any time. Tactile hallucinations are also known as haptic hallucinations. On the other hand, hypnopompic hallucinations are experienced upon waking up. It’s important to note that pseudohallucinations are not related to sleep and do not have the same quality as real perceptions.

    • This question is part of the following fields:

      • Descriptive Psychopathology
      5
      Seconds
  • Question 44 - Which type of brain lesion is typically associated with Alexia without agraphia? ...

    Correct

    • Which type of brain lesion is typically associated with Alexia without agraphia?

      Your Answer: Posterior cerebral artery

      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
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  • Question 45 - What is the term used to describe the process of reinforcing progressively more...

    Correct

    • What is the term used to describe the process of reinforcing progressively more accurate attempts towards a desired behavior?

      Your Answer: Shaping

      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
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  • Question 46 - At what stage of moral development is a teenager who feels guilty for...

    Incorrect

    • At what stage of moral development is a teenager who feels guilty for not participating in a school fundraiser? No one knows he was not allowed to sell raffle tickets door to door by his mother and was given money instead.

      Your Answer: Social contracts and individual rights

      Correct Answer: Maintaining the social order

      Explanation:

      If Peter had reached the stage of post-conventional morality, he would have evaluated whether purchasing sports equipment was a cause that aligned with his personal values and beliefs, rather than simply fulfilling a duty because his class was participating in it.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 47 - Which disorder is not included in the list of dissociative disorders in the...

    Correct

    • Which disorder is not included in the list of dissociative disorders in the ICD-11?

      Your Answer: Body integrity dysphoria

      Explanation:

      The classification of body integrity dysphoria falls under the group of conditions known as ‘disorders of bodily distress of bodily experience’, which was previously referred to as somatoform disorder.

      Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. Each disorder has its own set of essential features and diagnostic criteria.

    • This question is part of the following fields:

      • Classification And Assessment
      10.1
      Seconds
  • Question 48 - What was the psychiatric thinking model that George Engel advocated for? ...

    Incorrect

    • What was the psychiatric thinking model that George Engel advocated for?

      Your Answer: Diathesis-stress model

      Correct Answer: Biopsychosocial model

      Explanation:

      In 1977, Engel introduced the term ‘biopsychosocial model’ in an article for Science, advocating for a more comprehensive approach to understanding psychiatric illness. The biomedical model, which originated in the mid 19th Century, has been widely used. Aaron Beck has promoted the diathesis-stress model of psychopathology in relation to depression. August Weismann developed genetic determinism in 1890. Brown and Stewart, among others, have advocated for patient-centred care.

    • This question is part of the following fields:

      • Basic Ethics And Philosophy Of Psychiatry
      8
      Seconds
  • Question 49 - What brain structure is involved in the reward system and receives dopaminergic input...

    Correct

    • What brain structure is involved in the reward system and receives dopaminergic input from the ventral tegmental area through the mesolimbic dopamine pathway?

      Your Answer: Nucleus accumbens

      Explanation:

      Brain Anatomy

      The brain is a complex organ with various regions responsible for different functions. The major areas of the cerebrum (telencephalon) include the frontal lobe, parietal lobe, occipital lobe, temporal lobe, insula, corpus callosum, fornix, anterior commissure, and striatum. The cerebrum is responsible for complex learning, language acquisition, visual and auditory processing, memory, and emotion processing.

      The diencephalon includes the thalamus, hypothalamus and pituitary, pineal gland, and mammillary body. The thalamus is a major relay point and processing center for all sensory impulses (excluding olfaction). The hypothalamus and pituitary are involved in homeostasis and hormone release. The pineal gland secretes melatonin to regulate circadian rhythms. The mammillary body is a relay point involved in memory.

      The cerebellum is primarily concerned with movement and has two major hemispheres with an outer cortex made up of gray matter and an inner region of white matter. The cerebellum provides precise timing and appropriate patterns of skeletal muscle contraction for smooth, coordinated movements and agility needed for daily life.

      The brainstem includes the substantia nigra, which is involved in controlling and regulating activities of the motor and premotor cortical areas for smooth voluntary movements, eye movement, reward seeking, the pleasurable effects of substance misuse, and learning.

    • This question is part of the following fields:

      • Neurosciences
      7.6
      Seconds
  • Question 50 - What is a true statement about the planum temporale? ...

    Incorrect

    • What is a true statement about the planum temporale?

      Your Answer: Planum temporale asymmetry is often pronounced in dyslexia

      Correct Answer: Planum temporale asymmetry is more prominent in males than in females

      Explanation:

      Cerebral Asymmetry in Planum Temporale and its Implications in Language and Auditory Processing

      The planum temporale, a triangular region in the posterior superior temporal gyrus, is a highly lateralized brain structure involved in language and music processing. Studies have shown that the planum temporale is up to ten times larger in the left cerebral hemisphere than the right, with this asymmetry being more prominent in men. This asymmetry can be observed in gestation and is present in up to 70% of right-handed individuals.

      Recent research suggests that the planum temporale also plays an important role in auditory processing, specifically in representing the location of sounds in space. However, reduced planum temporale asymmetry has been observed in individuals with dyslexia, stuttering, and schizophrenia. These findings highlight the importance of cerebral asymmetry in the planum temporale and its implications in language and auditory processing.

    • This question is part of the following fields:

      • Neurosciences
      12.3
      Seconds
  • Question 51 - Which of the following indicates evidence of linkage based on the LOD score?...

    Correct

    • Which of the following indicates evidence of linkage based on the LOD score?

      Your Answer: > 3

      Explanation:

      Linkage and LOD Scores in Genetics

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

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

    • This question is part of the following fields:

      • Genetics
      5.5
      Seconds
  • Question 52 - Which individual is recognized for originating the term cognitive dissonance? ...

    Correct

    • Which individual is recognized for originating the term cognitive dissonance?

      Your Answer: Festinger

      Explanation:

      Cognitive Dissonance is a term used to describe the uncomfortable feeling that arises when there is a conflict between an individual’s attitudes, beliefs, of behaviors. This feeling can lead to a change in behavior of beliefs. The theory of cognitive dissonance suggests that people have an inner drive to maintain cognitive consistency and avoid dissonance. This drive can result in irrational of maladaptive behaviors. Dissonance can be reduced by changing attitudes, behaviors, of beliefs, acquiring new information, of reducing the importance of the cognitions. Overall, cognitive dissonance plays a significant role in shaping human behavior and decision-making.

    • This question is part of the following fields:

      • Social Psychology
      5.5
      Seconds
  • Question 53 - Can you identify the brain structure that is not found in both cerebral...

    Correct

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

      Your Answer: Pineal gland

      Explanation:

      Neuroanatomical Structures

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

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

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

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

    • This question is part of the following fields:

      • Neurosciences
      10
      Seconds
  • Question 54 - What is commonly used as a measure of intelligence prior to the onset...

    Correct

    • What is commonly used as a measure of intelligence prior to the onset of illness of injury?

      Your Answer: National adult reading test

      Explanation:

      The NART is a widely accepted assessment tool utilized for approximating an individual’s intelligence level prior to the onset of any cognitive impairment.

      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
      4.5
      Seconds
  • Question 55 - What does axis 3 of ICD-10 refer to? ...

    Correct

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

      Your Answer: Current psychosocial problems

      Explanation:

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

    • This question is part of the following fields:

      • Classification And Assessment
      9.3
      Seconds
  • Question 56 - What is a true statement about diazepam? ...

    Incorrect

    • What is a true statement about diazepam?

      Your Answer: Bioavailability is equal after oral and IV intake

      Correct Answer: It is 95% protein bound

      Explanation:

      Pharmacokinetics of Benzodiazepines

      Benzodiazepines are a class of drugs that are easily absorbed when taken orally. They have a high affinity for plasma proteins, with diazepam showing a binding rate of 95%. These drugs are primarily metabolized in the liver. Due to their lipophilic nature, they can quickly cross the blood-brain barrier and placental barrier. This property makes them effective in treating anxiety and other related disorders. Understanding the pharmacokinetics of benzodiazepines is crucial in determining their efficacy and potential side effects.

    • This question is part of the following fields:

      • Psychopharmacology
      12.4
      Seconds
  • Question 57 - A new parent tells you that lately, when they hear the sound of...

    Correct

    • A new parent tells you that lately, when they hear the sound of the dishwasher running, they think they have heard their infant fussing. However, when they turn off the dishwasher, the fussing has ceased.

      of what phenomenon is this an instance?

      Your Answer: Functional hallucination

      Explanation:

      There are several types of perceptual experiences that fall under the category of hallucinations of synaesthesia. Functional hallucinations occur when a normal perception leads to a hallucinatory perception of the same modality, such as hearing music when a tap is running. Delusional perception, on the other hand, is a primary delusional experience that starts with a normal perception and is not an hallucination. Gedankenlautwerden is the experience of hearing one’s thoughts spoken aloud as they are thought, while reflex hallucination occurs when a stimulus in one sensory modality leads to an hallucination in another modality. Finally, synaesthesia is the automatic and involuntary experience of a stimulus in one sensory of cognitive pathway in a second pathway, such as experiencing letters of numbers as inherently coloured.

    • This question is part of the following fields:

      • Descriptive Psychopathology
      11
      Seconds
  • Question 58 - What is the typical range for a 'normal' IQ score? ...

    Correct

    • What is the typical range for a 'normal' IQ score?

      Your Answer: 70-130

      Explanation:

      An IQ within the range of 70-130 is considered normal, which corresponds to two standard deviations above of below the average IQ of 100. This means that about 95% of the population falls within this range.

    • This question is part of the following fields:

      • Classification And Assessment
      6.8
      Seconds
  • Question 59 - Which of the following definitions best describes the term chorea? ...

    Correct

    • Which of the following definitions best describes the term chorea?

      Your Answer: Brief, quasi-purposeful, irregular contractions that are not repetitive of rhythmic

      Explanation:

      It is important to note that chorea and athetosis are two distinct movement disorders that are often confused. In chorea, the movements are characterized by quick, jerky motions, while in athetosis, there is a continuous flow of movement that is often described as worm-like. Athetosis involves a smooth, writhing motion, whereas chorea is more dance-like, with discrete movements that are not as continuous as those seen in athetosis.

      Movement Disorders: Key Features

      Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:

      Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.

      Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.

      Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.

      Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.

      Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.

      Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.

      Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.

      Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.

      Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.

      Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.

      Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.

      Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.

      Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.

      It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.

    • This question is part of the following fields:

      • Classification And Assessment
      16.3
      Seconds
  • Question 60 - From which structure are the cerebral peduncles derived? ...

    Incorrect

    • From which structure are the cerebral peduncles derived?

      Your Answer: Diencephalon

      Correct Answer: Mesencephalon

      Explanation:

      Neurodevelopment: Understanding Brain Development

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

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

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

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

    • This question is part of the following fields:

      • Neurosciences
      8.1
      Seconds
  • Question 61 - You observe a 42-year-old woman with delusions referred by her primary care physician....

    Incorrect

    • You observe a 42-year-old woman with delusions referred by her primary care physician. She is convinced that George Clooney is deeply in love with her. Over the past two months, she has attempted to send him 50 handwritten letters, along with numerous gifts. She frequently visits locations associated with the actor and places where he is attending public events. She believes that he is unable to express his true feelings for her due to the potential backlash from his wife and fans. What syndrome is being exhibited in this scenario?

      Your Answer: Ekbom's syndrome

      Correct Answer: De Clérambault's syndrome

      Explanation:

      De Clérambault’s syndrome is characterized by amorous delusions where the patient believes that a person of higher social status, often a public figure, is in love with them. These delusions are not based on any actual contact of encouragement from the subject. Patients with this syndrome may also experience delusions of persecution. Due to their strong belief in the reality of their delusions, patients often lack insight and may not seek help. Treatment can include psychotherapy and antipsychotics. Other syndromes with delusional symptoms include Capgras syndrome, Cotard’s syndrome, Ekbom’s syndrome, and Othello’s syndrome.

    • This question is part of the following fields:

      • Diagnosis
      19.3
      Seconds
  • Question 62 - A 40 year old female is admitted to the ward with a diagnosis...

    Correct

    • A 40 year old female is admitted to the ward with a diagnosis of depression. On admission the doctor notes skin changes consistent with erythema nodosum and also notes that the patient complains of being short of breath. Unfortunately the lady commits suicide shortly after admission. A post-mortem biopsy reveals Asteroid bodies. Which of the following diagnosis would you most suspect?:

      Your Answer: Sarcoidosis

      Explanation:

      Pathology Findings in Psychiatry

      There are several pathology findings that are associated with various psychiatric conditions. Papp-Lantos bodies, for example, are visible in the CNS and are associated with multisystem atrophy. Pick bodies, on the other hand, are large, dark-staining aggregates of proteins in neurological tissue and are associated with frontotemporal dementia.

      Lewy bodies are another common pathology finding in psychiatry and are associated with Parkinson’s disease and Lewy Body dementia. These are round, concentrically laminated, pale eosinophilic cytoplasmic inclusions that are aggregates of alpha-synuclein.

      Other pathology findings include asteroid bodies, which are associated with sarcoidosis and berylliosis, and are acidophilic, stellate inclusions in giant cells. Barr bodies are associated with stains of X chromosomes and are inactivated X chromosomes that appear as a dark staining mass in contact with the nuclear membrane.

      Mallory bodies are another common pathology finding and are associated with alcoholic hepatitis, alcoholic cirrhosis, Wilson’s disease, and primary-biliary cirrhosis. These are eosinophilic intracytoplasmic inclusions in hepatocytes that are made up of intermediate filaments, predominantly prekeratin.

      Other pathology findings include Schaumann bodies, which are associated with sarcoidosis and berylliosis, and are concentrically laminated inclusions in giant cells. Zebra bodies are associated with Niemann-Pick disease, Tay-Sachs disease, of any of the mucopolysaccharidoses and are palisaded lamellated membranous cytoplasmic bodies seen in macrophages.

      LE bodies, also known as hematoxylin bodies, are associated with SLE (lupus) and are nuclei of damaged cells with bound anti-nuclear antibodies that become homogeneous and loose chromatin pattern. Verocay bodies are associated with Schwannoma (Neurilemoma) and are palisades of nuclei at the end of a fibrillar bundle.

      Hirano bodies are associated with normal aging but are more numerous in Alzheimer’s disease. These are eosinophilic, football-shaped inclusions seen in neurons of the brain. Neurofibrillary tangles are another common pathology finding in Alzheimer’s disease and are made up of microtubule-associated proteins and neurofilaments.

      Kayser-Fleischer rings are associated with Wilson’s disease and are rings of discoloration on the cornea. Finally, Kuru plaques are associated with Kuru and Gerstmann-Sträussler syndrome and are sometimes present in patients with Creutzfeldt-Jakob disease (CJD). These are composed partly of a host-encoded prion protein.

    • This question is part of the following fields:

      • Neurosciences
      10.9
      Seconds
  • Question 63 - Which condition is most commonly associated with the presence of eosinophilic cytoplasmic inclusion...

    Correct

    • Which condition is most commonly associated with the presence of eosinophilic cytoplasmic inclusion bodies containing alpha-synuclein?

      Your Answer: Lewy body dementia

      Explanation:

      Lewy body dementia is a neurodegenerative disorder that is characterized by both macroscopic and microscopic changes in the brain. Macroscopically, there is cerebral atrophy, but it is less marked than in Alzheimer’s disease, and the brain weight is usually in the normal range. There is also pallor of the substantia nigra and the locus coeruleus, which are regions of the brain that produce dopamine and norepinephrine, respectively.

      Microscopically, Lewy body dementia is characterized by the presence of intracellular protein accumulations called Lewy bodies. The major component of a Lewy body is alpha synuclein, and as they grow, they start to draw in other proteins such as ubiquitin. Lewy bodies are also found in Alzheimer’s disease, but they tend to be in the amygdala. They can also be found in healthy individuals, although it has been suggested that these may be pre-clinical cases of dementia with Lewy bodies. Lewy bodies are also found in other neurodegenerative disorders such as progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy.

      In Lewy body dementia, Lewy bodies are mainly found within the brainstem, but they are also found in non-brainstem regions such as the amygdaloid nucleus, parahippocampal gyrus, cingulate cortex, and cerebral neocortex. Classic brainstem Lewy bodies are spherical intraneuronal cytoplasmic inclusions, characterized by hyaline eosinophilic cores, concentric lamellar bands, narrow pale halos, and immunoreactivity for alpha synuclein and ubiquitin. In contrast, cortical Lewy bodies typically lack a halo.

      Most brains with Lewy body dementia also show some plaques and tangles, although in most instances, the lesions are not nearly as severe as in Alzheimer’s disease. Neuronal loss and gliosis are usually restricted to brainstem regions, particularly the substantia nigra and locus ceruleus.

    • This question is part of the following fields:

      • Neurosciences
      6.8
      Seconds
  • Question 64 - Which component is not considered a key element in Link and Phelan's stigma...

    Incorrect

    • Which component is not considered a key element in Link and Phelan's stigma model?

      Your Answer: Status loss

      Correct Answer: Scapegoating

      Explanation:

      Stigma Models

      Stigma refers to any attribute, trait, of disorder that marks an individual as being unacceptably different from the normal people with whom they routinely interact, and that elicits some form of community sanction. The most popular model of stigma comes from the work of Link and Phelan, which has four aspects to it.

      The first aspect is labelling, which refers to personal characteristics that mark individuals as different. These characteristics can be physical, mental, of social in nature and can include things like race, gender, sexual orientation, of mental illness.

      The second aspect is stereotyping, which involves linking labelled characteristics to undesirable characteristics. For example, people with mental illness may be stereotyped as violent of unpredictable, even though the vast majority of them are not.

      The third aspect is separating, which involves separating the labelled group and normal people by viewing them as very different. This can lead to social isolation and exclusion, which can further exacerbate the negative effects of stigma.

      The fourth and final aspect is status loss and discrimination, which refers to the devaluing, rejecting, and excluding of the labelled group. This can take many forms, including employment discrimination, housing discrimination, and social exclusion.

      Overall, the model of stigma developed by Link and Phelan provides a useful framework for understanding the complex and multifaceted nature of stigma and its effects on individuals and society as a whole.

    • This question is part of the following fields:

      • Social Psychology
      13.1
      Seconds
  • Question 65 - What is the most distinguishing feature of Parkinsonism? ...

    Correct

    • What is the most distinguishing feature of Parkinsonism?

      Your Answer: Bradykinesia

      Explanation:

      Movement Disorders: Key Features

      Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:

      Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.

      Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.

      Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.

      Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.

      Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.

      Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.

      Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.

      Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.

      Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.

      Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.

      Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.

      Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.

      Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.

      It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.

    • This question is part of the following fields:

      • Classification And Assessment
      6.2
      Seconds
  • Question 66 - What type of antidepressant medication did Carlsson create in the late 1960s? ...

    Incorrect

    • What type of antidepressant medication did Carlsson create in the late 1960s?

      Your Answer: TCA

      Correct Answer: SSRI

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Psychopharmacology
      4.3
      Seconds
  • Question 67 - What is a typical developmental milestone in children? ...

    Incorrect

    • What is a typical developmental milestone in children?

      Your Answer: First appearance of social smile at 4 months

      Correct Answer: Begins to sit unsupported at 8 months of age

      Explanation:

      Starting to sit unsupported at 8 months is considered normal as it falls within the expected range of achieving this milestone by 9 months. However, the other choices suggest a delay in development.

      The Emergence of Social Smiling in Infants

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

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

    • This question is part of the following fields:

      • Psychological Development
      11.2
      Seconds
  • Question 68 - Which statement accurately describes interactions involving chlorpromazine? ...

    Incorrect

    • Which statement accurately describes interactions involving chlorpromazine?

      Your Answer: Valproic acid decreases the serum concentration of chlorpromazine

      Correct Answer: Chlorpromazine increases the serum concentration of valproic acid

      Explanation:

      The serum concentration of valproic acid may be elevated by chlorpromazine, although the reason for this is not fully understood. However, this outcome is widely acknowledged.

      Chlorpromazine: Photosensitivity Reactions and Patient Precautions

      Chlorpromazine, the first drug used for psychosis, is a common topic in exams. However, it is important to note that photosensitivity reactions are a known side effect of its use. Patients taking chlorpromazine should be informed of this and advised to take necessary precautions. Proper education and awareness can help prevent potential harm from photosensitivity reactions.

    • This question is part of the following fields:

      • Psychopharmacology
      10.8
      Seconds
  • Question 69 - What are the defining features of Klein's depressive position? ...

    Correct

    • What are the defining features of Klein's depressive position?

      Your Answer: Ambivalence

      Explanation:

      Melanie Klein, a prominent psychoanalyst, introduced two significant concepts in her work: the paranoid-schizoid position and the depressive position. The paranoid-schizoid position is a state of mind where the individual perceives the world as fragmented, dividing it into good and bad. This position is characterized by the defense mechanism of splitting, where the individual separates the good and bad aspects of themselves and others.

      On the other hand, the depressive position follows the paranoid-schizoid position and is characterized by the ability to accept ambivalence, where something can be both good and bad. This position represents a more integrated state of mind, where the individual can hold conflicting emotions and thoughts simultaneously. These concepts have been influential in psychoanalytic theory and have contributed to our understanding of the human psyche.

    • This question is part of the following fields:

      • Social Psychology
      13.3
      Seconds
  • Question 70 - Which of the following describes the concept of 'goodness of fit', the reciprocal...

    Correct

    • Which of the following describes the concept of 'goodness of fit', the reciprocal relationship between a child's personality and their surroundings?

      Your Answer: Thomas and Chess

      Explanation:

      The concept of ‘goodness of fit’ was introduced by Thomas and Chess, which refers to the interdependent relationship between a child’s temperament and their environment that impacts their development. The strange situation procedure is linked to Ainsworth, while Bowlby is known for his research on attachment and maternal deprivation. Main is recognized for developing the adult attachment interview. Winnicott coined the term ‘good-enough mother’.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 71 - In what society is the fear of 'losing face' and the desire to...

    Correct

    • In what society is the fear of 'losing face' and the desire to avoid it associated with a significant number of suicides?

      Your Answer: South Asian

      Explanation:

      Mediterranean countries typically have lower suicide rates compared to South Asian cultures, where the public loss of credibility, of losing face, is often catastrophize and can lead to a higher incidence of suicide, as seen in Sri Lanka.

    • This question is part of the following fields:

      • Stigma And Culture
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  • Question 72 - Which antipsychotic medication has the strongest impact on the QTc interval? ...

    Correct

    • Which antipsychotic medication has the strongest impact on the QTc interval?

      Your Answer: Haloperidol

      Explanation:

      Amantadine and QTc Prolongation

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 73 - Which of the following is an example of a compound question? ...

    Correct

    • Which of the following is an example of a compound question?

      Your Answer: Do you limit what you eat and exercise to keep thin?

      Explanation:

      Understanding Compound Questions in Interview Techniques

      When conducting interviews, it is important to be aware of compound questions. These are questions that combine multiple inquiries into what appears to be a single question. Compound questions can be confusing for the interviewee and may lead to inaccurate of incomplete responses.

      To avoid compound questions, it is important to break down inquiries into separate, clear questions. This allows the interviewee to fully understand what is being asked and provide a thoughtful response. Additionally, it is important to avoid using conjunctions such as and of of when asking questions, as this can create compound questions.

      By using clear and concise language and avoiding compound questions, interviewers can ensure that they are receiving accurate and complete responses from their interviewees. This can lead to a more successful and informative interview process.

    • This question is part of the following fields:

      • Classification And Assessment
      15.5
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  • Question 74 - What specific warnings should be given to patients who are prescribed tranylcypromine? ...

    Correct

    • What specific warnings should be given to patients who are prescribed tranylcypromine?

      Your Answer: Hypertensive crisis

      Explanation:

      It is important to provide education to patients who are prescribed MAOIs regarding the dietary restrictions that must be followed in order to avoid a hypertensive crisis.

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

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

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

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

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

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 75 - What is the primary neurotransmitter responsible for excitatory signals in the brain? ...

    Correct

    • What is the primary neurotransmitter responsible for excitatory signals in the brain?

      Your Answer: Glutamate

      Explanation:

      Glutamate is the primary neurotransmitter responsible for excitatory signaling in the brain.

      Glutamate: The Most Abundant Neurotransmitter in the Brain

      Glutamate is a neurotransmitter that is found in abundance in the brain. It is always excitatory and can act through both ionotropic and metabotropic receptors. This neurotransmitter is believed to play a crucial role in learning and memory processes. Its ability to stimulate neurons and enhance synaptic plasticity is thought to be responsible for its role in memory formation. Glutamate is also involved in various other brain functions, including motor control, sensory perception, and emotional regulation. Its importance in the brain makes it a target for various neurological disorders, including Alzheimer’s disease, Parkinson’s disease, and epilepsy.

    • This question is part of the following fields:

      • Neurosciences
      4
      Seconds
  • Question 76 - What is the suggested way in which St John's Wort works? ...

    Correct

    • What is the suggested way in which St John's Wort works?

      Your Answer: SNRI and MAOI

      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
      2.2
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  • Question 77 - What is the accurate statement about Thurstone's scale? ...

    Correct

    • What is the accurate statement about Thurstone's scale?

      Your Answer: It is time consuming

      Explanation:

      The Thurstone scale’s reliability is limited due to the process of constructing it. While a large number of statements are collected and edited for clarity and relevance, the final form of the scale only includes items that have high interjudge agreement and fall at equal intervals. This selective process may result in a scale that is not entirely reliable.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 78 - Which of the following is not a factor that increases the risk of...

    Incorrect

    • Which of the following is not a factor that increases the risk of developing neuroleptic malignant syndrome when administering antipsychotics?

      Your Answer: Sudden withdrawal of anticholinergic agents

      Correct Answer: Being female

      Explanation:

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 79 - Which type of axon is responsible for the intense and sudden pain experienced...

    Correct

    • Which type of axon is responsible for the intense and sudden pain experienced during an injury?

      Your Answer: A-delta

      Explanation:

      Primary Afferent Axons: Conveying Information about Touch and Pain

      Primary afferent axons play a crucial role in conveying information about touch and pain from the surface of the body to the spinal cord and brain. These axons can be classified into four types based on their functions: A-alpha (proprioception), A-beta (touch), A-delta (pain and temperature), and C (pain, temperature, and itch). While all A axons are myelinated, C fibers are unmyelinated.

      A-delta fibers are responsible for the sharp initial pain, while C fibers are responsible for the slow, dull, longer-lasting second pain. Understanding the different types of primary afferent axons and their functions is essential in diagnosing and treating various sensory disorders.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 80 - What is the most ancient technique employed for treating mental disorders? ...

    Correct

    • What is the most ancient technique employed for treating mental disorders?

      Your Answer: Trephination

      Explanation:

      Trephination, the act of creating a hole in a living person’s skull, is believed to be the earliest form of surgery. It was likely used to treat various ailments such as convulsions, headaches, infections, and fractures, of to allow the exit of entrance of spirits thought to cause illness. The practice was also used in ancient Egypt, where skull scrapings were used to create medicinal potions. Trephination was written about by both Hippocrates and Galen and continued to be performed throughout the Middle Ages and into the Renaissance. Evidence of successful operations can be seen in skulls that show bone regrowth, suggesting that many people survived the treatment.

    • This question is part of the following fields:

      • History Of Psychiatry
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  • Question 81 - Which antidepressant works by inhibiting the reuptake of dopamine? ...

    Incorrect

    • Which antidepressant works by inhibiting the reuptake of dopamine?

      Your Answer: Trazodone

      Correct Answer: Bupropion

      Explanation:

      Bupropion inhibits the reuptake of noradrenaline and dopamine, making it an NDRI.

      Mechanisms of Action of Different Drugs

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 82 - What is a distinguishing characteristic of normal pressure hydrocephalus? ...

    Correct

    • What is a distinguishing characteristic of normal pressure hydrocephalus?

      Your Answer: Incontinence

      Explanation:

      Headache, nausea, vomiting, papilledema, and ocular palsies are symptoms of increased intracranial pressure, which are not typically present in cases of normal pressure hydrocephalus.

      Normal Pressure Hydrocephalus

      Normal pressure hydrocephalus is a type of chronic communicating hydrocephalus, which occurs due to the impaired reabsorption of cerebrospinal fluid (CSF) by the arachnoid villi. Although the CSF pressure is typically high, it remains within the normal range, and therefore, it does not cause symptoms of high intracranial pressure (ICP) such as headache and nausea. Instead, patients with normal pressure hydrocephalus usually present with a classic triad of symptoms, including incontinence, gait ataxia, and dementia, which is often referred to as wet, wobbly, and wacky. Unfortunately, this condition is often misdiagnosed as Parkinson’s of Alzheimer’s disease.

      The classic triad of normal pressure hydrocephalus, also known as Hakim’s triad, includes gait instability, urinary incontinence, and dementia. On the other hand, non-communicating hydrocephalus results from the obstruction of CSF flow in the third of fourth ventricle, which causes symptoms of raised intracranial pressure, such as headache, vomiting, hypertension, bradycardia, altered consciousness, and papilledema.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 83 - Out of the options provided, which one is the least probable cause of...

    Correct

    • Out of the options provided, which one is the least probable cause of delirium?

      Your Answer: Lansoprazole

      Explanation:

      Prescribing in the Elderly: Iatrogenic Consequences

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

      Medications Linked to Delirium and Other Cognitive Disorders

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

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

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

      Medications Linked to Mood Changes

      The following medications are well known to precipitate mood changes:

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

      Medications Linked to Psychosis

      The following medications are well known to precipitate psychosis:

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

      Medications Linked to Anxiety

      The following medications are well known to precipitate anxiety:

      – Stimulants
      – β adrenergic inhalers

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 84 - What is the recommended course of treatment for a man who experiences depression...

    Correct

    • What is the recommended course of treatment for a man who experiences depression after a heart attack?

      Your Answer: Sertraline

      Explanation:

      SSRIs, of selective serotonin reuptake inhibitors, are the first-line treatment for depression in most patients. However, some SSRIs have different side effects and interactions than others. For example, fluoxetine, fluvoxamine, and paroxetine have a higher propensity for drug interactions, while citalopram is useful for elderly patients as it is associated with lower risks of drug interactions. SSRIs should be used with caution in children and adolescents, and fluoxetine is the drug of choice in this population.

      Common side effects of SSRIs include gastrointestinal symptoms, sedation, and sexual dysfunction. Paroxetine is considered the most sedating and anticholinergic, while vortioxetine is associated with the least sexual dysfunction. Patients taking SSRIs are at an increased risk of gastrointestinal bleeding, and a proton pump inhibitor should be prescribed if they are also taking an NSAID.

      When stopping a SSRI, the dose should be gradually reduced over a 4 week period, except for fluoxetine. Paroxetine has a higher incidence of discontinuation symptoms, which can include mood changes, restlessness, difficulty sleeping, and gastrointestinal symptoms.

      SSRIs can also have interactions with other medications, such as NSAIDs, warfarin/heparin, aspirin, and triptans. Patients should be reviewed by a doctor after starting antidepressant therapy, and if they make a good response, they should continue treatment for at least 6 months after remission to reduce the risk of relapse.

      In patients who have had a myocardial infarction, approximately 20% develop depression. SSRIs are the preferred antidepressant group post-MI, but they can increase the bleeding risk, especially in those using anticoagulation. Mirtazapine is an alternative option, but it too is associated with bleeding. The SADHART study found sertraline to be a safe treatment for depression post-myocardial infarction.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 85 - What is the function of the Nissl substance within a neuron? ...

    Correct

    • What is the function of the Nissl substance within a neuron?

      Your Answer: Protein synthesis

      Explanation:

      Melanin

      Melanin is a pigment found in various parts of the body, including the skin, hair, and eyes. It is produced by specialized cells called melanocytes, which are located in the skin’s basal layer. The function of melanin in the body is not fully understood, but it is thought to play a role in protecting the skin from the harmful effects of ultraviolet (UV) radiation from the sun. Additionally, melanin may be a by-product of neurotransmitter synthesis, although this function is not well established. Overall, the role of melanin in the body is an area of ongoing research.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 86 - If a man experiences a severe road traffic accident resulting in substantial damage...

    Correct

    • If a man experiences a severe road traffic accident resulting in substantial damage to his frontal lobe, what symptoms would you anticipate him to exhibit?

      Your Answer: Contralateral hemiplegia

      Explanation:

      Cerebral Dysfunction: Lobe-Specific Features

      When the brain experiences dysfunction, it can manifest in various ways depending on the affected lobe. In the frontal lobe, dysfunction can lead to contralateral hemiplegia, impaired problem solving, disinhibition, lack of initiative, Broca’s aphasia, and agraphia (dominant). The temporal lobe dysfunction can result in Wernicke’s aphasia (dominant), homonymous upper quadrantanopia, and auditory agnosia (non-dominant). On the other hand, the non-dominant parietal lobe dysfunction can lead to anosognosia, dressing apraxia, spatial neglect, and constructional apraxia. Meanwhile, the dominant parietal lobe dysfunction can result in Gerstmann’s syndrome. Lastly, occipital lobe dysfunction can lead to visual agnosia, visual illusions, and contralateral homonymous hemianopia.

    • This question is part of the following fields:

      • Neurosciences
      28.5
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  • Question 87 - What substance belongs to the category of catecholamines? ...

    Correct

    • What substance belongs to the category of catecholamines?

      Your Answer: Dopamine

      Explanation:

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

    • This question is part of the following fields:

      • Neurosciences
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  • Question 88 - A 70 year old woman with post-stroke cognitive deficits is referred for an...

    Correct

    • A 70 year old woman with post-stroke cognitive deficits is referred for an assessment of intelligence. Which test would give the best indication of her intelligence as it was before she had a stroke?

      Your Answer: The National Adult Reading Test

      Explanation:

      The National Adult Reading Test as a Valid Measure of Premorbid Intelligence

      The National Adult Reading Test (NART) is a reliable and valid assessment tool for measuring premorbid intelligence. It comprises 50 words with irregular spellings, and the test-taker must correctly pronounce each word to receive a point. The NART is a useful tool for assessing cognitive function in individuals with neurological disorders of brain injuries, as it provides a baseline measure of their intellectual abilities before the onset of their condition. The NART is a widely used and respected measure of premorbid intelligence, and its results can inform clinical decision-making and treatment planning.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 89 - How does bupropion work? ...

    Correct

    • How does bupropion work?

      Your Answer: NDRI (noradrenaline dopamine reuptake inhibitor)

      Explanation:

      Bupropion is classified as a noradrenaline dopamine reuptake inhibitor (NDRI) and functions by elevating the levels of neurotransmitters such as noradrenaline and dopamine. It has been utilized as an antidepressant and a smoking cessation aid.

    • This question is part of the following fields:

      • Psychopharmacology
      10.9
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  • Question 90 - A 35-year-old male reported experiencing the scent of lavender when he listens to...

    Correct

    • A 35-year-old male reported experiencing the scent of lavender when he listens to music. What is the most probable explanation for this phenomenon?

      Your Answer: Synaesthesia

      Explanation:

      Hallucinations and Illusions

      Hallucinations can take on different forms, including reflex hallucinations, auditory hallucinations, and functional hallucinations. Reflex hallucinations occur when a stimulus in one sensory modality produces a hallucination in another. For example, someone may smell oranges when they hear music. Auditory hallucinations, on the other hand, are the presence of auditory experiences in the absence of a true stimulus. Functional hallucinations occur when an external stimulus provokes a hallucination, and the normal perception of the external stimulus and the hallucinatory experience are in the same modality.

      In addition to hallucinations, there are also illusions, which involve false perceptions with sensory distortions. Kinaesthetic hallucinations are a type of hallucination that involve bodily movements. Understanding the different types of hallucinations and illusions can help individuals better recognize and manage these experiences.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 91 - QTc prolongation is associated with which of the following metabolic changes? ...

    Correct

    • QTc prolongation is associated with which of the following metabolic changes?

      Your Answer: Hypokalaemia

      Explanation:

      Amantadine and QTc Prolongation

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 92 - A pediatrician sees a young patient with complaints of anxiety in the office....

    Correct

    • A pediatrician sees a young patient with complaints of anxiety in the office. Which scale would be the most suitable to assess the intensity of their anxiety?

      Your Answer: Hamilton anxiety rating scale

      Explanation:

      The Hamilton anxiety rating scale (HAM-A) is a clinician-rated scale that measures the severity of anxiety symptoms in adults, adolescents, and children. It takes about 10-15 minutes to administer and consists of 14 items that measure both mental and physical symptoms of anxiety. Each item is scored on a scale of 0-4, with a total score range of 0-56. The impact of events scale is used to measure stress reactions after traumatic events, while the state-trait anxiety inventory (STAI) is a self-report inventory that measures both state and trait anxiety. The Zung self-rated anxiety scale is a patient-rated scale that measures anxiety levels based on cognitive, autonomic, motor, and central nervous system symptoms.

    • This question is part of the following fields:

      • Description And Measurement
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  • Question 93 - How can a group of genetic defects causing a single condition be described?...

    Incorrect

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

      Your Answer: Pleiotropy

      Correct Answer: Heterogeneity

      Explanation:

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

      Understanding Heterogeneity in Genetic Diseases

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

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

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

    • This question is part of the following fields:

      • Genetics
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  • Question 94 - A 65-year-old individual presents with a sudden onset of horizontal diplopia. Upon examination,...

    Correct

    • A 65-year-old individual presents with a sudden onset of horizontal diplopia. Upon examination, you note that they have an inability to move their left eye laterally. Which cranial nerve is most likely affected?

      Your Answer: VI

      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
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  • Question 95 - Which of the following statements is most in line with the International Classification...

    Correct

    • Which of the following statements is most in line with the International Classification of Diseases (ICD-11) guidelines?

      Your Answer: International classification of diseases uses the term mental disorder

      Explanation:

      Classification of Diseases: A Brief Overview

      A scientific classification system should have standardized names, clear operational criteria, and a multiaxial arrangement for citing important attributes. The International Classification of Diseases (ICD) has been the main nosologic system for identifying human ailments for the past century. It has a well-organized and widely accepted nomenclature, but lacks operational criteria and an appropriate multiaxial pattern. The ICD-10 is available in major languages and classifies psychiatric conditions under Mental and behavioural disorders in Chapter V. However, it does not include social consequences of the disorder, which is included in the DSM IV under Axis 4 (Psychosocial and Environmental Problems). Neurasthenia is classified under Other neurotic disorders (F48.0) in the ICD-10. Overall, classification of diseases is a system of categories to which morbid entities are assigned according to established criteria.

    • This question is part of the following fields:

      • Classification And Assessment
      12.4
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  • Question 96 - What kind of tremor is commonly observed as a result of prolonged usage...

    Incorrect

    • What kind of tremor is commonly observed as a result of prolonged usage of antipsychotic drugs?

      Your Answer: Physiologic tremor

      Correct Answer: Parkinsonian tremor

      Explanation:

      Types of Tremor

      Essential Tremor

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

      Parkinsonian Tremor

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

      Cerebellar Tremor

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

      Psychogenic Tremor

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

      Physiologic Tremor

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

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

      Type of Tremor Frequency

      Intention 2-3Hz

      Parkinsonian 5Hz

      Essential 7Hz

      Physiological 10Hz

      Psychogenic variable

    • This question is part of the following fields:

      • Classification And Assessment
      7.7
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  • Question 97 - Which statement about pharmacokinetics in the elderly is incorrect? ...

    Correct

    • Which statement about pharmacokinetics in the elderly is incorrect?

      Your Answer: The volume of distribution for lipid-soluble drugs decreases with age

      Explanation:

      As people age, they tend to have less muscle mass, more fat, and less water in their bodies. As a result, drugs that dissolve in fat tend to spread out more in their bodies. This can cause the effects of these drugs to last longer even after they stop taking them.

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

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

    • This question is part of the following fields:

      • Psychopharmacology
      20.3
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  • Question 98 - A 50-year-old female with a history of bipolar disorder presents with an acute...

    Correct

    • A 50-year-old female with a history of bipolar disorder presents with an acute confusional state.

      Which one of the following drugs is most likely to precipitate lithium toxicity?

      Your Answer: Bendroflumethiazide

      Explanation:

      Plasma concentrations of lithium may be decreased by both sodium bicarbonate and aminophylline.

      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
      10.4
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  • Question 99 - What is a correct statement about the pathology of Lewy body dementia? ...

    Incorrect

    • What is a correct statement about the pathology of Lewy body dementia?

      Your Answer: Lewy bodies are not found in subcortical structures

      Correct Answer: There is a loss of dopaminergic neurons

      Explanation:

      Lewy body dementia is a neurodegenerative disorder that is characterized by both macroscopic and microscopic changes in the brain. Macroscopically, there is cerebral atrophy, but it is less marked than in Alzheimer’s disease, and the brain weight is usually in the normal range. There is also pallor of the substantia nigra and the locus coeruleus, which are regions of the brain that produce dopamine and norepinephrine, respectively.

      Microscopically, Lewy body dementia is characterized by the presence of intracellular protein accumulations called Lewy bodies. The major component of a Lewy body is alpha synuclein, and as they grow, they start to draw in other proteins such as ubiquitin. Lewy bodies are also found in Alzheimer’s disease, but they tend to be in the amygdala. They can also be found in healthy individuals, although it has been suggested that these may be pre-clinical cases of dementia with Lewy bodies. Lewy bodies are also found in other neurodegenerative disorders such as progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy.

      In Lewy body dementia, Lewy bodies are mainly found within the brainstem, but they are also found in non-brainstem regions such as the amygdaloid nucleus, parahippocampal gyrus, cingulate cortex, and cerebral neocortex. Classic brainstem Lewy bodies are spherical intraneuronal cytoplasmic inclusions, characterized by hyaline eosinophilic cores, concentric lamellar bands, narrow pale halos, and immunoreactivity for alpha synuclein and ubiquitin. In contrast, cortical Lewy bodies typically lack a halo.

      Most brains with Lewy body dementia also show some plaques and tangles, although in most instances, the lesions are not nearly as severe as in Alzheimer’s disease. Neuronal loss and gliosis are usually restricted to brainstem regions, particularly the substantia nigra and locus ceruleus.

    • This question is part of the following fields:

      • Neurosciences
      10.7
      Seconds
  • Question 100 - Which of the following diseases is not caused by prions? ...

    Incorrect

    • Which of the following diseases is not caused by prions?

      Your Answer: Kuru

      Correct Answer: Progressive supranuclear palsy

      Explanation:

      Prion Diseases

      Prion diseases are a group of rare and fatal neurodegenerative disorders that affect humans and animals. These diseases are caused by abnormal proteins called prions, which can cause normal proteins in the brain to fold abnormally and form clumps. This leads to damage and death of brain cells, resulting in a range of symptoms such as dementia, movement disorders, and behavioral changes.

      Some of the most well-known prion diseases in humans include Creutzfeldt-Jakob disease, Kuru, Gerstman-Straussler-Scheinker syndrome, and Fatal Familial Insomnia. Creutzfeldt-Jakob disease is the most common prion disease in humans, and it can occur sporadically, genetically, of through exposure to contaminated tissue. Kuru is a rare disease that was once prevalent in Papua New Guinea, and it was transmitted through cannibalism. Gerstman-Straussler-Scheinker syndrome is a rare genetic disorder that affects the nervous system, while Fatal Familial Insomnia is a rare inherited disorder that causes progressive insomnia and other neurological symptoms.

      Despite extensive research, there is currently no cure for prion diseases, and treatment is mainly supportive. Prevention measures include avoiding exposure to contaminated tissue and practicing good hygiene.

    • This question is part of the following fields:

      • Neurosciences
      4.6
      Seconds
  • Question 101 - The term used to describe the ability of a 25 year old man...

    Correct

    • The term used to describe the ability of a 25 year old man to smell music is:

      Your Answer: Synaesthesia

      Explanation:

      Synaesthesia is a condition in which stimulation of one sensory pathway results in experiences in another sensory pathway, such as perceiving a scent as a sound of visualizing a sound as a color.

      Altered Perceptual Experiences

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

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

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

    • This question is part of the following fields:

      • Classification And Assessment
      4.5
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  • Question 102 - Which attachment theorist differentiated between deprivation and privation? ...

    Correct

    • Which attachment theorist differentiated between deprivation and privation?

      Your Answer: Spitz

      Explanation:

      René Spitz’s Study on Anaclitic Depression in Children

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

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
      8.1
      Seconds
  • Question 103 - Can you identify a condition that falls under the category of tauopathy? ...

    Correct

    • Can you identify a condition that falls under the category of tauopathy?

      Your Answer: Pick's disease

      Explanation:

      Tau and Tauopathies

      Tau proteins are essential for maintaining the stability of microtubules in neurons. Microtubules provide structural support to the cell and facilitate the transport of molecules within the cell. Tau proteins are predominantly found in the axons of neurons and are absent in dendrites. The gene that codes for tau protein is located on chromosome 17.

      When tau proteins become hyperphosphorylated, they clump together, forming neurofibrillary tangles. This process leads to the disintegration of cells, which is a hallmark of several neurodegenerative disorders collectively known as tauopathies.

      The major tauopathies include Alzheimer’s disease, Pick’s disease (frontotemporal dementia), progressive supranuclear palsy, and corticobasal degeneration. These disorders are characterized by the accumulation of tau protein in the brain, leading to the degeneration of neurons and cognitive decline. Understanding the role of tau proteins in these disorders is crucial for developing effective treatments for these devastating diseases.

    • This question is part of the following fields:

      • Genetics
      4.8
      Seconds
  • Question 104 - Which wave pattern is considered the most abnormal during a state of wakefulness?...

    Correct

    • Which wave pattern is considered the most abnormal during a state of wakefulness?

      Your Answer: Delta

      Explanation:

      Electroencephalography

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

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

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

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

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

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

    • This question is part of the following fields:

      • Neurosciences
      5.9
      Seconds
  • Question 105 - What factor increases the risk of developing SIADH? ...

    Incorrect

    • What factor increases the risk of developing SIADH?

      Your Answer: Having a high BMI

      Correct Answer: Being female

      Explanation:

      Hyponatremia in Psychiatric Patients

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

    • This question is part of the following fields:

      • Psychopharmacology
      10.8
      Seconds
  • Question 106 - Which of the options has the lowest degree of first pass effect association?...

    Incorrect

    • Which of the options has the lowest degree of first pass effect association?

      Your Answer: Imipramine

      Correct Answer: Pregabalin

      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
      8
      Seconds
  • Question 107 - A 42-year-old female with a history of bipolar disorder is undergoing second line...

    Correct

    • A 42-year-old female with a history of bipolar disorder is undergoing second line mood stabilisation therapy due to inadequate response to first line agents. She was discovered unconscious on the street. She has no history of seizures of fainting. All laboratory tests are normal except for a serum sodium level of 105 mmol/L (135-150). What is the most probable cause of this?

      Your Answer: Carbamazepine

      Explanation:

      Monitoring for hyponatraemia is essential when administering carbamazepine due to its established side effect. However, it is important to note that NICE recommends lithium, olanzapine, and valproate as first line agents for treating bipolar disorder, with carbamazepine being a second line option.

    • This question is part of the following fields:

      • Psychopharmacology
      23.1
      Seconds
  • Question 108 - Which antidepressant is known for having a lower occurrence of sexual dysfunction as...

    Correct

    • Which antidepressant is known for having a lower occurrence of sexual dysfunction as a side effect?

      Your Answer: Mirtazapine

      Explanation:

      Antidepressants can cause sexual dysfunction as a side-effect, although the rates vary. The impact on sexual desire, arousal, and orgasm can differ depending on the type of antidepressant. It is important to rule out other causes and consider non-pharmacological strategies such as reducing the dosage of taking drug holidays. If necessary, switching to a lower risk antidepressant of using pharmacological options such as phosphodiesterase inhibitors of mirtazapine augmentation can be considered. The Maudsley Guidelines 14th Edition provides a helpful table outlining the risk of sexual dysfunction for different antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
      8.8
      Seconds
  • Question 109 - Identify the option that represents a secondary reinforcer. ...

    Correct

    • Identify the option that represents a secondary reinforcer.

      Your Answer: Money

      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
      5
      Seconds
  • Question 110 - Which condition has the highest estimate of heritability among the options provided? ...

    Correct

    • Which condition has the highest estimate of heritability among the options provided?

      Your Answer: Schizophrenia

      Explanation:

      Heritability: Understanding the Concept

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

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

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

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

    • This question is part of the following fields:

      • Genetics
      8.9
      Seconds
  • Question 111 - What is the most effective method for distinguishing between Alzheimer's disease and Lewy...

    Correct

    • What is the most effective method for distinguishing between Alzheimer's disease and Lewy body dementia?

      Your 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
      9.3
      Seconds
  • Question 112 - Which antidepressant is known for having a lower occurrence of sexual dysfunction as...

    Correct

    • Which antidepressant is known for having a lower occurrence of sexual dysfunction as a side effect?

      Your Answer: Mirtazapine

      Explanation:

      Antidepressants can cause sexual dysfunction as a side-effect, although the rates vary. The impact on sexual desire, arousal, and orgasm can differ depending on the type of antidepressant. It is important to rule out other causes and consider non-pharmacological strategies such as reducing the dosage of taking drug holidays. If necessary, switching to a lower risk antidepressant of using pharmacological options such as phosphodiesterase inhibitors of mirtazapine augmentation can be considered. The Maudsley Guidelines 14th Edition provides a helpful table outlining the risk of sexual dysfunction for different antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
      3.3
      Seconds
  • Question 113 - What ethical perspective are both teenagers employing when discussing the potential impact of...

    Correct

    • What ethical perspective are both teenagers employing when discussing the potential impact of assisting a patient in dying on the public's trust in doctors?

      Your Answer: Utilitarian

      Explanation:

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

    • This question is part of the following fields:

      • Basic Ethics And Philosophy Of Psychiatry
      9.8
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  • Question 114 - In what century did psychiatry become established as a distinct medical field? ...

    Correct

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

      Your Answer: 18th century

      Explanation:

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

    • This question is part of the following fields:

      • History Of Psychiatry
      4.3
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  • Question 115 - Which cognitive function is the Stroop test intended to detect difficulties with? ...

    Correct

    • Which cognitive function is the Stroop test intended to detect difficulties with?

      Your Answer: Response inhibition

      Explanation:

      The Stroop test involves presenting words to the subject that spell a color but are written in a different color. The subject is required to identify the color of the text as quickly as possible, rather than reading the word itself. This test assesses the subject’s ability to make an appropriate response when presented with conflicting signals. This ability is believed to originate from the anterior cingulate, which is located between the left and right frontal lobes.

      Frontal Lobe Tests

      The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.

      Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.

      Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.

      Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.

      Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.

      Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.

    • This question is part of the following fields:

      • Classification And Assessment
      5.7
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  • Question 116 - What distinguishing characteristics indicate a diagnosis of dissociative non-epileptic attacks (pseudoseizures) instead of...

    Correct

    • What distinguishing characteristics indicate a diagnosis of dissociative non-epileptic attacks (pseudoseizures) instead of generalized tonic-clonic seizures?

      Your Answer: Gradual onset