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Question 1
Incorrect
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Which condition is characterized by microcephaly?
Your Answer: Fragile X syndrome
Correct Answer: Fetal alcohol syndrome
Explanation:Microcephaly is a characteristic of fetal alcohol syndrome, while macrocephaly is associated with all the other options except for Asperger’s, which is not typically linked to any abnormality in head size.
Microcephaly: A Condition of Small Head Size
Microcephaly is a condition characterized by a small head size. It can be a feature of various conditions, including fetal alcohol syndrome, Down’s syndrome, Edward’s syndrome, Patau syndrome, Angelman syndrome, De Lange syndrome, Prader-Willi syndrome, and Cri-du-chat syndrome. Each of these conditions has its own unique set of symptoms and causes, but they all share the common feature of microcephaly. This condition can have a range of effects on a person’s development, including intellectual disability, seizures, and motor problems. Early diagnosis and intervention can help manage the symptoms and improve outcomes for individuals with microcephaly.
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This question is part of the following fields:
- Genetics
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Question 2
Incorrect
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What is a true statement about first rank symptoms?
Your Answer: They are pathognomonic of schizophrenia
Correct Answer: They have been reported in personality disorders
Explanation:Although first rank symptoms are commonly associated with schizophrenia, they are not considered diagnostic of pathognomonic of the disorder, as they can also be present in other conditions. It is important to note that these symptoms were not originally designed for diagnostic purposes, but rather as a screening tool.
First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 3
Incorrect
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What is the alternative name for Briquet's syndrome in the field of psychiatry?
Your Answer: Dissociative amnesia
Correct Answer: Bodily distress disorder
Explanation:In 1859, Pierre Briquet, a French physician and psychologist, released his Treatise on Hysteria, which established the foundation for the contemporary diagnosis of somatization disorder (also known as Briquet syndrome). The ICD-11 now refers to this as bodily distress 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.
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This question is part of the following fields:
- Classification And Assessment
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Question 4
Incorrect
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You are on call for a general medical ward and are asked to evaluate a 45-year-old woman who has been experiencing intermittent confusion and aggression for the past three days. She recently recovered from a severe respiratory infection but has been experiencing 20-minute periods of lucidity and confusion, preceded by abdominal discomfort. There is no history of substance abuse of alcohol dependence, and all blood and urine tests have come back negative. A CT scan of her brain is normal, and she has not been taking her prescribed medication during her hospital stay. What is the most likely diagnosis?
Your Answer: Acute confusional state
Correct Answer: Temporal lobe epilepsy
Explanation:Differential Diagnosis for a Patient with Temporal Lobe Epilepsy
Temporal lobe epilepsy, also known as complex partial seizures, is characterized by an aura of abdominal symptoms followed by altered consciousness and behavior. This episodic condition can occur rapidly. The presenting symptoms of this patient suggest an acute confusional state, ruling out antibiotic-induced psychosis, which is associated with ongoing antibiotic treatment. Delirium tremens, a severe form of alcohol withdrawal, is also unlikely. Early onset dementia cannot be associated with this presentation due to insufficient information. A differential diagnosis is necessary to determine the underlying cause of the patient’s symptoms.
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This question is part of the following fields:
- Diagnosis
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Question 5
Incorrect
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A child complains that people's heads seem to appear larger than they should in relation to their bodies.
Which of the following best describes their experience?Your Answer: Hypnagogic hallucination
Correct Answer: Dysmegalopsia
Explanation:Dysmegalopsia: Difficulty in Perceiving Object Size
Dysmegalopsia is a condition characterized by a reduced ability to accurately perceive the size of objects. This can manifest as either micropsia, where objects appear smaller than they actually are, of macropsia, where objects appear larger than they actually are. Dysmegalopsia can occur as a standalone symptom of as part of a group of symptoms known as the Alice in Wonderland Syndrome. In this syndrome, individuals may experience distortions in their perception of size, shape, and distance, as well as other sensory disturbances. Dysmegalopsia can be caused by various factors, including neurological conditions, migraines, and the use of certain medications.
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This question is part of the following fields:
- Classification And Assessment
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Question 6
Incorrect
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Which statement accurately describes the placebo effect?
Your Answer: Placebos can be used effectively to distinguish between true and imagined disease
Correct Answer: The effects of placebos tend to be short lived
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.
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This question is part of the following fields:
- Classification And Assessment
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Question 7
Correct
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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.
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This question is part of the following fields:
- Neurosciences
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Question 8
Incorrect
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If two adults with an autosomal recessive condition have a child, what is the likelihood that the child will also have of develop the condition?
Your Answer: 50%
Correct Answer: 100%
Explanation:Mendelian Inheritance (Pedigrees)
Mendelian inheritance refers to the transmission patterns of genetic conditions caused by a mutation in a single gene. There are four types of Mendelian inheritance patterns: autosomal dominant, autosomal recessive, X-linked recessive, and X-linked dominant. Each pattern follows a predictable inheritance pattern within families.
Autosomal dominant conditions are expressed in individuals who have just one copy of the mutant allele. Affected males and females have an equal probability of passing on the trait to offspring. In contrast, autosomal recessive conditions are clinically manifest only when an individual has two copies of the mutant allele. X-linked recessive traits are fully evident in males because they only have one copy of the X chromosome, while women are rarely affected by X-linked recessive diseases. X-linked dominant disorders are clinically manifest when only one copy of the mutant allele is present.
Common examples of conditions with specific inheritance patterns include neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, Noonan’s syndrome for autosomal dominant; phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, cystic fibrosis for autosomal recessive; vitamin D resistant rickets, Rett syndrome for X-linked dominant; and cerebellar ataxia, Hunter’s syndrome, Lesch-Nyhan for X-linked recessive.
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This question is part of the following fields:
- Genetics
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Question 9
Incorrect
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A woman has a particular song that reminds her of an old boyfriend that broke up with her. Every time it is played she feels a deep sense of sadness. A classmate in her school often sings the song and the woman eventually finds herself feeling sad when she sees this classmate even when he no longer sings the song. This is an example of which of the following?
Your Answer: Stimulus generalisation
Correct Answer: Higher order conditioning
Explanation:The original response is elicited by the song, which serves as the conditioned stimulus. Through higher order conditioning, the colleague becomes associated with the song and also elicits the original response.
When a response conditioned to a specific stimulus occurs in response to other stimuli that are similar to the original stimulus, this is known as stimulus generalisation. For instance, if someone experiences fear after being stung by a bee (CS), they may also feel fearful towards other small flying insects due to their similarity to the conditioned stimulus.
In the given scenario, the colleague is dissimilar to the song and therefore cannot be considered as a similar stimulus. Hence, higher order conditioning is the appropriate term to describe the process.Classical Conditioning: A Learning Theory by Ivan Pavlov
Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.
Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.
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This question is part of the following fields:
- Social Psychology
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Question 10
Incorrect
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Which of the following is associated with paradoxical reactions in people with learning difficulties?
Your Answer: Cholinesterase inhibitors
Correct Answer: Benzodiazepines
Explanation:Disinhibitory Drug Reactions: Understanding Paradoxical Reactions to Benzodiazepines
Benzodiazepines are commonly prescribed for anxiety and sleep disorders, but they are also associated with paradoxical reactions, also known as disinhibitory reactions. These reactions are unexpected increases in aggressive behavior, sexual disinhibition, hyperactivity, vivid dreams, and hostility. However, the prevalence of these reactions is difficult to determine, as study findings vary widely from 1% to 58%.
Certain factors increase the risk of paradoxical reactions, including a history of aggression of poor impulse control, extremes of age (elderly of young), benzodiazepines with short half-lives, high doses of benzodiazepines, and intravenous administration of benzodiazepines. It is important to record these reactions, and if they are severe, it is advisable to avoid future use of benzodiazepines.
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This question is part of the following fields:
- Psychopharmacology
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Question 11
Correct
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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.
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This question is part of the following fields:
- Neurosciences
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Question 12
Incorrect
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What proportion of individuals who experience suicidal thoughts progress to making a plan and attempting suicide within the initial year of onset?
Your Answer: 10%
Correct Answer: 60%
Explanation:In a survey conducted by Nock et al.1, which involved interviewing more than 80,000 individuals across 17 countries regarding suicidal behaviors, it was discovered that 60% of individuals who transitioned from suicidal ideation to planning and attempting suicide did so within the first year of experiencing ideation.
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This question is part of the following fields:
- Epidemiology
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Question 13
Correct
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What is the purpose of using the AUDIT questionnaire?
Your Answer: Alcohol misuse
Explanation:Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 14
Incorrect
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What is the EEG waveform with the slowest frequency?
Your Answer: Beta
Correct Answer: Delta
Explanation:EEG Waveform Frequencies
Delta waves have the lowest frequency among the EEG waveforms, ranging from 0.5 to 4 Hz. Theta waves follow with a frequency range of 4 to 8 Hz, while alpha waves have a frequency range of 8 to 14 Hz. Beta waves have a frequency range of 14 to 32 Hz, and gamma waves have a frequency range of 32 to 48+ Hz. In a normal awake adult EEG, alpha waves are the most prominent waveform.
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This question is part of the following fields:
- Neurosciences
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Question 15
Incorrect
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How would you rephrase the term that refers to the use of words of phrases in a repetitive and meaningless manner?
Your Answer: Echopraxia
Correct Answer: Verbigeration
Explanation:– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 16
Correct
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A 35-year-old individual with schizophrenia experiences the belief that their thoughts are being controlled externally through a process of telephony. What type of speech disorder is probable in this case?
Your Answer: Neologism
Explanation:Neologism is a symptom of schizophrenia where a person creates new words of uses existing words in a way that only makes sense to them. Alogia is a difficulty in speaking, which can be caused by a lack of thoughts of negative thought disorder. Clang associations occur when words are linked based on their sound rather than their meaning. Logoclonia is a condition where a person gets stuck on a particular word, often repeating syllables of parts of words. Stuttering is a speech disorder characterized by involuntary repetitions, prolongations, and pauses in speech.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 17
Incorrect
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A 45-year-old woman complains of feeling excessively sleepy during the day and experiencing auditory hallucinations upon waking up. She also reports instances of feeling paralyzed even after awakening. What is the probable diagnosis?
Your Answer: REM behavioural disorder
Correct Answer: Narcolepsy
Explanation:The symptoms described in the scenario are indicative of narcolepsy, specifically hypnopompic hallucinations and sleep paralysis. Narcolepsy is characterized by a set of symptoms including sleep attacks, cataplexy, sleep paralysis, and hypnagogic or hypnopompic hallucinations. Primary hypersomnia is excessive daytime sleepiness without the associated features of other sleep disorders of narcolepsy. REM sleep behavioral disorder (RBD) is characterized by complex behaviors during sleep, typically occurring during the longest periods of REM sleep and accompanied by vivid dream recall. Sleep terror disorder, also known as night terror, occurs during partial arousal from delta sleep and is typically amnestic. In contrast, the patient in the scenario was able to recall the episode of sleep paralysis. Schizophrenia cannot be diagnosed based on the symptoms described, as the criteria for hallucinations and an additional symptom from criterion A must be present for a significant portion of the time, and the symptoms can be attributed to narcolepsy.
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This question is part of the following fields:
- Diagnosis
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Question 18
Correct
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Which cranial nerve nuclei would be affected by a midbrain lesion?
Your Answer: Oculomotor
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.
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This question is part of the following fields:
- Neurosciences
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Question 19
Incorrect
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What is the estimated percentage of Caucasians who have the homozygous isoform of alcohol dehydrogenase ADH1B*1?
Your Answer: 5-10%
Correct Answer: 85-95%
Explanation:This question is challenging as it requires an estimation of the percentage of Caucasians who possess two copies of the gene responsible for the slow-acting form of alcohol dehydrogenase.
Genetics and Alcoholism
Alcoholism tends to run in families, and several studies confirm that biological children of alcoholics are more likely to develop alcoholism even when adopted by parents without the condition. Monozygotic twins have a greater concordance rate for alcoholism than dizygotic twins. Heritability estimates range from 45 to 65 percent for both men and women. While genetic differences affect risk, there is no “gene for alcoholism,” and both environmental and social factors weigh heavily on the outcome.
The genes with the clearest contribution to the risk for alcoholism and alcohol consumption are alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). The first step in ethanol metabolism is oxidation to acetaldehyde, by ADHs. The second step is metabolism of the acetaldehyde to acetate by ALDHs. Individuals carrying even a single copy of the ALDH2*504K display the “Asian flushing reaction” when they consume even small amounts of alcohol. There is one significant genetic polymorphism of the ALDH2 gene, resulting in allelic variants ALDH2*1 and ALDH2*2, which is virtually inactive. ALDH2*2 is present in about 50 percent of the Taiwanese, Han Chinese, and Japanese populations. It is extremely rare outside Asia. Nearly no individuals of European of African descent carry this allele. ALDH2*504K has repeatedly been demonstrated to have a protective effect against alcohol use disorders.
The three different class I gene loci, ADH1A (alpha), ADH1B (beta), and ADH1C (gamma) are situated close to each other in the region 4q2123. The alleles ADH1C*1 and ADH1B*2 code for fast metabolism of alcohol. The ADH1B*1 slow allele is very common among Caucasians, with approximately 95 percent having the homozygous ADH1B*1/1 genotype and 5 percent having the heterozygous ADH1B*1/2 genotype. The ADH1B*2 allele is the most common allele in Asian populations. In African populations, the ADH1B*1 allele is the most common.
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This question is part of the following fields:
- Genetics
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Question 20
Incorrect
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Which of the following is excluded from the frontal assessment battery?
Your Answer: Ask the patient how two items are similar and different
Correct Answer: Asking the patient to draw a clock
Explanation:The Frontal Assessment Battery (FAB) is a quick and easy bedside test used to detect the dysexecutive syndrome. It consists of six subsets, including conceptualization, mental flexibility, motor programming, conflicting instructions, go-no go (inhibitory control), and prehension behavior. The test assesses a patient’s ability to perform tasks such as abstract reasoning, verbal fluency, and motor skills. The FAB can be completed in just a few minutes and is a useful tool for clinicians in evaluating patients with suspected executive dysfunction.
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This question is part of the following fields:
- Classification And Assessment
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Question 21
Correct
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What is a true statement about antidepressant medications that are not taken orally?
Your Answer: Compared to orally administered antidepressants, those given intravenously tend to require lower doses
Explanation:Intravenous formulations bypass the initial metabolism in the liver, resulting in increased concentrations of the drug in the bloodstream.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 22
Incorrect
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Which compound was created through the synthesis of chlorpromazine?
Your Answer: Delay and Deniker
Correct Answer: Charpentier
Explanation:In 1951, Charpentier in France synthesised Chlorpromazine with the aim of creating a centrally acting antihistamine to assist with general anaesthesia. Later, studies conducted by Delay and Deniker provided evidence for its effectiveness in treating schizophrenia.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 23
Incorrect
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A teenager who is a victim of a crime is more likely to receive assistance from a bystander if:
Your Answer: There are a large number of bystanders
Correct Answer: The bystander is male
Explanation:The Bystander Effect: Theory and Examples
The bystander effect, also known as the Genovese effect, suggests that the likelihood of someone helping in a situation is inversely related to the number of people present. This means that a person is more likely to help if there are fewer witnesses. The term Genovese effect comes from the case of Kitty Genovese, who was sexually assaulted and killed in front of a large apartment building. Despite 38 neighbors hearing her screams, no one called the police. However, the facts of this story have been largely shown to be inaccurate.
Bystanders are less likely to help if there are many other people present, if the perpetrator is present, if the costs of intervention are physical, and if the situation is perceived as dangerous. On the other hand, bystanders are more likely to help if they are male and if they know the person in need of help. Overall, the bystander effect has been shown to be a valid concept, as demonstrated by research studies.
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This question is part of the following fields:
- Social Psychology
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Question 24
Correct
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A 25-year-old bipolar patient tells his therapist that he plans to harm his ex-girlfriend who he believes is stalking him. He claims that his delusions are telling him to take action. The therapist decides to notify the ex-girlfriend and the authorities. What legal obligation does the therapist have to warn and protect the potential victim?
Your Answer: Tarasoff II
Explanation:The Durham rule states that an individual cannot be held criminally responsible if their unlawful actions were a result of a mental disease of defect. The M’Naghten rule, on the other hand, states that a person is not guilty by reason of insanity if they were unaware of the nature and quality of their actions due to a mental disease, of if they knew their actions were wrong. Additionally, the common law principle of necessity allows for reasonable force and necessary treatment to be used on individuals who lack capacity.
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This question is part of the following fields:
- Basic Ethics And Philosophy Of Psychiatry
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Question 25
Incorrect
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What hormone is secreted by the gastrointestinal tract and has a significant impact on digestion and feelings of fullness?
Your Answer: Leu-encephalin
Correct Answer: Cholecystokinin
Explanation:Cholecystokinin (CCK) is a hormone produced and released by the duodenum that stimulates the secretion of digestive enzymes and bile, while also acting as an appetite suppressant. corticotropin releasing hormone is secreted by the paraventricular nucleus of the hypothalamus and triggers the release of ACTH from the pituitary gland. Met- and Leu- encephalin are peptides that play a role in pain modulation. α-endorphin is one of several endorphins that can inhibit pain and induce a feeling of euphoria.
Source: https://www.ncbi.nlm.nih.gov/pubmed/16246215
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This question is part of the following fields:
- Neurosciences
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Question 26
Incorrect
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Who conducted the experiment On being sane in insane places where eight individuals feigned psychiatric illness to gain admission to a mental hospital and then had difficulty being released of having their diagnosis removed?
Your Answer: Michel Foucault
Correct Answer: DL Rosenhan
Explanation:Erik Erikson is associated with transactional analysis
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This question is part of the following fields:
- History Of Psychiatry
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Question 27
Incorrect
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You are employed at a psychiatric inpatient unit where several patients are taking clozapine. Among the following patients, who would you suspect to have the lowest plasma clozapine levels if they were all taking the same dose?
Your Answer: A 60-year-old Afro-Caribbean male non-smoker
Correct Answer: A 25-year-old Caucasian male smoker
Explanation:Younger patients, males, and smokers typically exhibit lower plasma levels of clozapine, while the Asian population tends to have higher levels.
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This question is part of the following fields:
- Psychopharmacology
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Question 28
Incorrect
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What gene is thought to be abnormal in individuals diagnosed with tuberous sclerosis?
Your Answer: MeCP2
Correct Answer: TSC1
Explanation:Rett syndrome is caused by mutations in the MeCP2 gene.
Tuberous Sclerosis: A Neurocutaneous Syndrome with Psychiatric Comorbidity
Tuberous sclerosis is a genetic disorder that affects multiple organs, including the brain, and is associated with significant psychiatric comorbidity. This neurocutaneous syndrome is inherited in an autosomal dominant pattern with a high penetrance rate of 95%, but its expression can vary widely. The hallmark of this disorder is the growth of multiple non-cancerous tumors in vital organs, including the brain. These tumors result from mutations in one of two tumor suppressor genes, TSC1 and TSC2. The psychiatric comorbidities associated with tuberous sclerosis include autism, ADHD, depression, anxiety, and even psychosis.
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This question is part of the following fields:
- Genetics
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Question 29
Incorrect
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Which of the following lists 11 therapeutic of 'healing' factors that are unique to group therapy?
Your Answer: Foulkes
Correct Answer: Yalom
Explanation:Irvin Yalom identified 11 therapeutic factors that are unique to group therapy, including universality, altruism, instillation of hope, imparting of information, corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, group cohesiveness, existential factors, catharsis, and interpersonal learning. Group therapy has been practiced by various pioneers in the field, such as Bion at the Tavistock Clinic, Foulkes who developed group analysis, Moreno who is associated with psychodrama, and Pratt who was an early advocate of group therapy in the United States.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 30
Incorrect
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Which of the following stages is not included in Bowlby's four stages of attachment?
Your Answer: Preattachment
Correct Answer: Operational attachment
Explanation:Attachment Theory and Harlow’s Monkeys
Attachment theory, developed by John Bowlby, suggests that children have an innate tendency to form relationships with people around them to increase their chance of survival. This attachment is different from bonding, which concerns the mother’s feelings for her infant. Children typically single out a primary caregiver, referred to as the principle attachment figure, from about 1-3 months. The quality of a person’s early attachments is associated with their adult behavior, with poor attachments leading to withdrawn individuals who struggle to form relationships and good attachments leading to socially competent adults who can form healthy relationships.
Bowlby’s attachment model has four stages: preattachment, attachment in the making, clear-cut attachment, and formation of reciprocal attachment. The time from 6 months to 36 months is known as the critical period, during which a child is most vulnerable to interruptions in its attachment. Attachments are divided into secure and insecure types, with insecure types further divided into avoidant and ambivalent types.
Harlow’s experiment with young rhesus monkeys demonstrated the importance of the need for closeness over food. The experiment involved giving the monkeys a choice between two different mothers, one made of soft terry cloth but provided no food and the other made of wire but provided food from an attached baby bottle. The baby monkeys spent significantly more time with their cloth mother than with their wire mother, showing the importance of attachment and closeness in early development.
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This question is part of the following fields:
- Psychological Development
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