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Question 1
Correct
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What is the purpose of the Sally-Anne test?
Your Answer: Theory of mind
Explanation:The Sally-Anne Test and the Theory of Mind
The Sally-Anne test, conducted by Simon Baron-Cohen, led to the development of the theory of mind idea. The experiment involved several groups of children, including those with autism. During the test, a skit was performed where Sally put a marble in a basket and left the room. Anne then removed the marble from the basket and placed it in a box. When Sally returned, the children were asked where she would look for her marble.
The results showed that most non-autistic children correctly identified the basket, while most autistic children pointed to of named the box. This led the researchers to conclude that the autistic children who chose the box lacked the ability to understand that Sally did not know the marble was in the box. The Sally-Anne test thus became a crucial tool in understanding the theory of mind, which refers to the ability to attribute mental states to oneself and others.
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This question is part of the following fields:
- Social Psychology
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Question 2
Correct
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Which of the following medications has a chemical composition that closely resembles diazepam?
Your Answer: Chlordiazepoxide
Explanation:Chlordiazepoxide belongs to the benzodiazepine class of drugs and shares a similar chemical structure with diazepam.
Clomethiazole is a type of hypnotic that is not classified as a benzodiazepine.
Chloroquine is primarily used as an antimalarial medication.
Chlorphenamine is an antihistamine drug.
Chlorpromazine is classified as a typical antipsychotic medication. -
This question is part of the following fields:
- Psychopharmacology
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Question 3
Incorrect
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Which concept is linked to the term 'eudaimonia'?
Your Answer: Utilitarianism
Correct Answer: Virtue ethics
Explanation:Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.
More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.
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This question is part of the following fields:
- Social Psychology
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Question 4
Correct
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If a patient suspected of having a stroke presents with a deviation of the tongue towards the right, which nerve is likely to be impacted?
Your Answer: Right hypoglossal nerve
Explanation:The hypoglossal nerve (nerve XII) is responsible for controlling the motor functions of the tongue and the muscles surrounding the hyoid bone. As a result, when there is a lesion on the right side, the tongue will tend to deviate towards that side. It is important to note that the hypoglossal nerve is purely a motor nerve and does not have any sensory component.
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 5
Incorrect
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Which of the options below does not have an effect on GABA?
Your Answer: Zopiclone
Correct Answer: Phenytoin
Explanation:The mechanism of action of phenytoin involves the stabilization of sodium channels.
Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 6
Incorrect
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A 35-year-old woman has just started taking antipsychotic medication for the first time after being diagnosed with schizophrenia. Her spouse asks you when they can expect to see the most significant improvement in her symptoms.
Your advice would be:Your Answer: Week 4 to week 5
Correct Answer: Within week 1
Explanation:The onset of antipsychotic effect is noticeable within the first week of treatment, as reported by a large meta-analysis of almost 7,500 patients. This study found that there was a significant improvement of nearly 22% in the first two weeks of treatment, which contradicts the previous belief that it may take two to four weeks for antipsychotic action to take effect. The reduction in BPRS scores was as follows: 13.8% within the first week, 8.1% in the second week, 4.2% in the third week, and 4.7% in the fourth week.
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This question is part of the following fields:
- Psychopharmacology
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Question 7
Correct
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Which of the following does not follow an autosomal recessive inheritance pattern?
Your Answer: Noonan's syndrome
Explanation:Inheritance Patterns and Examples
Autosomal Dominant:
Neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, and Noonan’s syndrome are all examples of conditions that follow an autosomal dominant inheritance pattern. This means that only one copy of the mutated gene is needed to cause the condition.Autosomal Recessive:
Phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, and cystic fibrosis are all examples of conditions that follow an autosomal recessive inheritance pattern. This means that two copies of the mutated gene are needed to cause the condition.X-Linked Dominant:
Vitamin D resistant rickets and Rett syndrome are examples of conditions that follow an X-linked dominant inheritance pattern. This means that the mutated gene is located on the X chromosome and only one copy of the gene is needed to cause the condition.X-Linked Recessive:
Cerebellar ataxia, Hunter’s syndrome, and Lesch-Nyhan are examples of conditions that follow an X-linked recessive inheritance pattern. This means that the mutated gene is located on the X chromosome and two copies of the gene are needed to cause the condition.Mitochondrial:
Leber’s hereditary optic neuropathy and Kearns-Sayre syndrome are examples of conditions that follow a mitochondrial inheritance pattern. This means that the mutated gene is located in the mitochondria and is passed down from the mother to her offspring. -
This question is part of the following fields:
- Genetics
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Question 8
Incorrect
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What is the definition of secondary deviance?
Your Answer: The effect on other family members of an individual being labelled as deviant
Correct Answer: An individual's reaction to experiences resulting from being labelled as deviant
Explanation:Primary deviance refers to the initial act of breaking a social rule of expectation, which may include health-related norms. On the other hand, secondary deviance describes the consequences of being stigmatized as a result of the primary deviant behavior. An example of this could be an individual joining a gang as a means of finding acceptance after being rejected by mainstream society. For more information on this topic, one can refer to resources such as SOS Sociology.
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This question is part of the following fields:
- Stigma And Culture
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Question 9
Correct
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Which cognitive function is primarily evaluated by the task of copying intersecting pentagons in the MMSE?
Your Answer: Constructional apraxia
Explanation:The primary purpose of intersecting pentagons is to evaluate constructional apraxia, with attention being a secondary factor.
Apraxia: Understanding the Inability to Carry Out Learned Voluntary Movements
Apraxia is a neurological condition that affects a person’s ability to carry out learned voluntary movements. It is important to note that this condition assumes that everything works and the person is not paralyzed. There are different types of apraxia, each with its own set of symptoms and characteristics.
Limb kinetic apraxia is a type of apraxia that affects a person’s ability to make fine of delicate movements. This can include tasks such as buttoning a shirt of tying shoelaces.
Ideomotor apraxia, on the other hand, is an inability to carry out learned tasks when given the necessary objects. For example, a person with ideomotor apraxia may try to write with a hairbrush instead of using it to brush their hair.
Constructional apraxia affects a person’s ability to copy a picture of combine parts of something to form a whole. This can include tasks such as building a puzzle of drawing a picture.
Ideational apraxia is an inability to follow a sequence of actions in the correct order. For example, a person with ideational apraxia may struggle to take a match out of a box and strike it with their left hand.
Finally, oculomotor apraxia affects a person’s ability to control eye movements. This can make it difficult for them to track moving objects of read smoothly.
Overall, apraxia can have a significant impact on a person’s ability to carry out everyday tasks. However, with the right support and treatment, many people with apraxia are able to improve their abilities and maintain their independence.
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This question is part of the following fields:
- Neurosciences
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Question 10
Incorrect
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A 70-year-old woman is undergoing a medical procedure and is unable to verbally communicate. The nurse provides her with a pen and paper to express any concerns of questions she may have about the procedure.
What principle of the Mental Capacity Act 2005 is the nurse attempting to uphold?Your Answer: A person must be assumed to have capacity unless it is established that he does lack capacity
Correct Answer: A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
Explanation:In accordance with the Mental Capacity Act 2005, it is important to recognize that a person should not be considered lacking capacity unless all possible measures have been taken to assist them. The Act also establishes several principles, including the assumption that a person has capacity unless proven otherwise, and that a person should not be deemed incapable of making decisions without adequate support. Additionally, making an unwise decision does not necessarily indicate a lack of capacity. Any actions of decisions made on behalf of a person lacking capacity must be made in their best interests, and consideration should be given to whether there are less restrictive options available.
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This question is part of the following fields:
- Basic Ethics And Philosophy Of Psychiatry
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Question 11
Correct
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What is a true statement about the cerebellum?
Your Answer: The vestibulocerebellum controls balance and spatial orientation
Explanation:The Cerebellum: Anatomy and Function
The cerebellum is a part of the brain that consists of two hemispheres and a median vermis. It is separated from the cerebral hemispheres by the tentorium cerebelli and connected to the brain stem by the cerebellar peduncles. Anatomically, it is divided into three lobes: the flocculonodular lobe, anterior lobe, and posterior lobe. Functionally, it is divided into three regions: the vestibulocerebellum, spinocerebellum, and cerebrocerebellum.
The vestibulocerebellum, located in the flocculonodular lobe, is responsible for balance and spatial orientation. The spinocerebellum, located in the medial section of the anterior and posterior lobes, is involved in fine-tuned body movements. The cerebrocerebellum, located in the lateral section of the anterior and posterior lobes, is involved in planning movement and the conscious assessment of movement.
Overall, the cerebellum plays a crucial role in motor coordination and control. Its different regions and lobes work together to ensure smooth and precise movements of the body.
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This question is part of the following fields:
- Neurosciences
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Question 12
Correct
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At what age does puberty need to begin for it to be considered precocious in girls?
Your Answer: 8
Explanation:Puberty
Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.
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This question is part of the following fields:
- Psychological Development
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Question 13
Incorrect
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What is the suggested way in which St John's Wort works?
Your Answer:
Correct 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.
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This question is part of the following fields:
- Psychopharmacology
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Question 14
Incorrect
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Which statement accurately describes pharmacokinetics in the elderly?
Your Answer:
Correct Answer: The glomerular filtration rate reduces with age
Explanation:Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.
In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.
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This question is part of the following fields:
- Psychopharmacology
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Question 15
Incorrect
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This is an example of a verbal fluency test, which assesses a person's ability to generate words within a specific category of starting with a particular letter. The man demonstrated good verbal fluency for words starting with F, but his performance decreased when asked to generate words starting with A. This could indicate a difficulty with cognitive flexibility of retrieval of information.
For instance, during clinical assessment, a 70-year-old woman is asked to name animals beginning with the letter B, which she does, naming ten words in one minute. She is then asked to name animals beginning with the letter G and replies, goat, giraffe....Your Answer:
Correct Answer: Perseveration
Explanation:To assess recall failure, the clinician typically asks the client to remember and then recall three objects after a delay. In the scenario described, the client’s difficulty cannot be attributed to a failure to maintain attention on the task, as their performance over the previous minute does not support this interpretation. However, the client’s perseveration in providing examples of words beginning with F suggests a possible issue with set-shifting, while expressive dysphasia may be identified through failure in speech of naming of objects during cognitive assessment. Disorientation, on the other hand, is typically evaluated through ten questions at the beginning of a mini-mental state examination of through screening questions during clinical assessment, and refers to a lack of recognition of place, time, of person.
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This question is part of the following fields:
- Cognitive Assessment
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Question 16
Incorrect
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Which antipsychotic medication has the strongest impact on the QTc interval?
Your Answer:
Correct 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.
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This question is part of the following fields:
- Psychopharmacology
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Question 17
Incorrect
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Which lobe is commonly linked to executive aprosody dysfunction?
Your Answer:
Correct Answer: Non-dominant frontal
Explanation:Understanding Prosody and Aprosodias
Prosody refers to the emotional tone of language, which is conveyed through the melodious quality and inflections in the voice. It is affected by various psychiatric and neuropsychiatric illnesses, and disorders in the ability to express of understand the emotional overlay of speech are called aprosodias. Aprosodias are typically caused by dysfunction in areas of the non-dominant hemisphere, usually the right side of the brain.
Executive aprosody, which is the ability to express emotions in speech, can be tested by asking the patient to repeat a neutral sentence with different emotions. It is affected by lesions of the right premotor cortex of the basal ganglia. On the other hand, receptive aprosody, which is the ability to understand emotions in speech, can be tested by asking the patient to identify the emotion conveyed in a neutral sentence with different emotional inflections. It is affected by lesions of the posterior superior right temporal lobe.
Abnormalities of prosody are not specific to any particular disorder, but patients with severe depression, schizophrenia, and pervasive developmental disorders often present with characteristic abnormalities of prosody. For instance, severely depressed patients may have a monotonous, affect-neutral pattern of speech, while patients with schizophrenia may present with abnormal modulation of emphasis and volume of unusual accents. Patients with autism and Asperger’s disorder may have speech patterns that are monotonous, robotic, of singsong in quality.
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This question is part of the following fields:
- Classification And Assessment
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Question 18
Incorrect
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Out of the options provided, which one is the least probable cause of delirium?
Your Answer:
Correct 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).
– CorticosteroidsMedications 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 19
Incorrect
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Which of the following conditions is not associated with an abnormality in the tau protein?
Your Answer:
Correct Answer: Hepatolenticular degeneration
Explanation:Wilson’s disease, also known as hepatolenticular degeneration, is identified by the accumulation of copper in the liver and brain.
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.
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This question is part of the following fields:
- Genetics
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Question 20
Incorrect
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A 32-year-old female patient with a diagnosis of alcohol use disorder is interested in decreasing her alcohol intake, but acknowledges that complete abstinence may not be achievable. What treatment options are appropriate in this case?
Your Answer:
Correct Answer: Nalmefene
Explanation:Alcohol Dependence Treatment Options
Nalmefene has recently been approved for reducing alcohol consumption in alcohol-dependent patients who have a high risk of drinking but do not experience physical withdrawal symptoms and do not require immediate detoxification.
Acamprosate, when used in conjunction with counseling, may help maintain abstinence in alcohol-dependent patients who experience strong cravings.
Bupropion hydrochloride, which has been used as an antidepressant, has been found to be effective in maintaining smoking cessation.
Disulfiram, when consumed with alcohol, causes an extremely unpleasant systemic reaction due to the accumulation of acetaldehyde.
Naltrexone, an opioid-receptor antagonist, may be used to treat alcohol dependence after successful withdrawal.
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This question is part of the following fields:
- Psychopharmacology
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Question 21
Incorrect
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Which allele is believed to have a protective effect against Alzheimer's disease?
Your Answer:
Correct Answer: APOE2
Explanation:APOE3 is considered to have a neutral effect on the risk of developing certain health conditions.
Genetics plays a role in the development of Alzheimer’s disease, with different genes being associated with early onset and late onset cases. Early onset Alzheimer’s, which is rare, is linked to three genes: amyloid precursor protein (APP), presenilin one (PSEN-1), and presenilin two (PSEN-2). The APP gene, located on chromosome 21, produces a protein that is a precursor to amyloid. The presenilins are enzymes that cleave APP to produce amyloid beta fragments, and alterations in the ratios of these fragments can lead to plaque formation. Late onset Alzheimer’s is associated with the apolipoprotein E (APOE) gene on chromosome 19, with the E4 variant increasing the risk of developing the disease. People with Down’s syndrome are also at high risk of developing Alzheimer’s due to inheriting an extra copy of the APP gene.
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This question is part of the following fields:
- Genetics
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Question 22
Incorrect
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What is the most common cause of SIADH?
Your Answer:
Correct Answer: Stroke
Explanation:It is crucial to recognize that SIADH can have various physical origins that could be the primary cause in a patient who has been given psychotropic medication and develops the condition. The hypothalamus can be affected by brain-related conditions such as stroke, leading to the development of SIADH. Additionally, it is important to remain vigilant for any underlying cancer.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 23
Incorrect
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Which of the following is not classified by the strange situation procedure as an attachment style?
Your Answer:
Correct Answer: Enmeshed
Explanation:Attachment (Ainsworth)
Psychologist Mary Ainsworth developed the ‘Strange Situation procedure’ to study and categorize attachment in children aged 12 to 18 months. The procedure involves seven steps, including two separations and two reunions, and takes place in one room. The child’s attachment is classified into one of three styles: secure, anxious-resistant, and anxious-avoidant. A fourth category, disorganized, is sometimes observed. Ainsworth suggested that the child’s attachment style is determined by the primary caregiver’s behavior.
Mary Main later developed the Adult Attachment Interview and identified four categories of attachment in adults that correspond to those observed in the strange situation. The distribution of adult attachment styles correlates with those of the strange situation, with 70% of children and adults having secure attachment. Attachment styles also seem to be passed on to subsequent generations.
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This question is part of the following fields:
- Psychological Development
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Question 24
Incorrect
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Which of the following conditions is characterized by an increase in the size of the ventricles on structural neuroimaging over time?
Your Answer:
Correct Answer: Alzheimer's dementia
Explanation:Neuroimaging studies have shown that Alzheimer’s dementia is linked to a gradual increase in ventricular size, while schizophrenia is associated with non-progressive enlargement of the lateral and third ventricles. Although some studies have reported increased ventricular size in individuals with affective disorders, the findings are not consistent. Additionally, individuals with antisocial personality disorder may have reduced prefrontal gray matter volume.
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This question is part of the following fields:
- Neurosciences
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Question 25
Incorrect
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Which statement accurately describes aneuploidy?
Your Answer:
Correct Answer: Most aneuploidies result from the nondisjunction of chromosomes during meiosis I
Explanation:Aneuploidy: Abnormal Chromosome Numbers
Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.
Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.
The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.
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This question is part of the following fields:
- Genetics
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Question 26
Incorrect
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A mother of a teenage girl recently diagnosed with Turner syndrome attends clinic with a number of questions. She is considering having another child. What should she know about Turner syndrome?
Your Answer:
Correct Answer: An increased risk of Turner syndrome in subsequent pregnancies has not been widely reported
Explanation:Most medical professionals recommend growth hormone therapy for girls diagnosed with Turner syndrome. Prenatal diagnosis can be achieved through chorionic villus sampling of amniocentesis, and while it has been traditionally believed that there is no increased risk in subsequent pregnancies, recent data suggests further studies are needed to confirm this.
Understanding Turner Syndrome
Turner syndrome is a genetic disorder that affects only females. It occurs when one of the two X chromosomes is missing of partially missing. This happens randomly and does not increase the risk of the condition in future siblings. Although X-inactivation occurs in females, having only one X chromosome can cause issues as not all genes are inactivated in the inactivated X chromosome.
The features of Turner syndrome include short stature, a webbed neck, a broad chest with widely spaced nipples, gonadal dysfunction leading to amenorrhea and infertility, congenital heart disease, and hypothyroidism. Despite these physical characteristics, girls with Turner syndrome typically have normal intelligence, with a mean full-scale IQ of 90. However, they may struggle with nonverbal, social, and psychomotor skills. It is important to understand the symptoms and effects of Turner syndrome to provide appropriate care and support for affected individuals.
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This question is part of the following fields:
- Psychological Development
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Question 27
Incorrect
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What does Bazett's formula correct for when deriving the corrected QT interval from the QT interval?
Your Answer:
Correct Answer: Heart rate
Explanation:Bazett’s formula adjusts the QT interval to account for variations in heart rate.
QTc Prolongation: Risks and Identification
The QT interval is a measure of the time it takes for the ventricles to repolarize and is calculated from the beginning of the QRS complex to the end of the T wave. However, the QT interval varies with the heart rate, making it difficult to use a single number as a cut-off for a prolonged QT. Instead, a corrected QT interval (QTc) is calculated for each heart rate using various formulas. A QTc over the 99th percentile is considered abnormally prolonged, with approximate values of 470 ms for males and 480 ms for females.
Prolonged QT intervals can lead to torsade de pointes (TdP), a polymorphic ventricular tachycardia that can be fatal if it degenerates into ventricular fibrillation. TdP is characterized by a twisting of the QRS complexes around an isoelectric line and is often asymptomatic but can also be associated with syncope and death. An accurate diagnosis requires an ECG to be recorded during the event. It is important to note that an increase in the QT interval due to a new conduction block should not be considered indicative of acquired LQTS and risk for TdP.
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This question is part of the following fields:
- Psychopharmacology
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Question 28
Incorrect
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What type of antidepressant is classified as specific for noradrenaline and serotonin?
Your Answer:
Correct Answer: Mirtazapine
Explanation:Antidepressants: Mechanism of Action
Antidepressants are a class of drugs used to treat depression and other mood disorders. The mechanism of action of antidepressants varies depending on the specific drug. Here are some examples:
Mirtazapine is a noradrenaline and serotonin specific antidepressant (NaSSa). It works by blocking certain receptors in the brain, including 5HT-1, 5HT-2, 5HT-3, and H1 receptors. It also acts as a presynaptic alpha 2 antagonist, which stimulates the release of noradrenaline and serotonin.
Venlafaxine and duloxetine are both serotonin and noradrenaline reuptake inhibitors (SNRIs). They work by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Reboxetine is a noradrenaline reuptake inhibitor (NRI). It works by blocking the reuptake of noradrenaline, which increases its availability in the brain.
Bupropion is a noradrenaline and dopamine reuptake inhibitor (NDRI). It works by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Trazodone is a weak serotonin reuptake inhibitor (SRI) and 5HT agonist. It works by increasing the availability of serotonin in the brain.
St John’s Wort is a natural supplement that has been used to treat depression. It has a weak monoamine oxidase inhibitor (MAOI) effect and a weak SNRI effect.
In summary, antidepressants work by increasing the availability of certain neurotransmitters in the brain, such as serotonin, noradrenaline, and dopamine. The specific mechanism of action varies depending on the drug.
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This question is part of the following fields:
- Psychopharmacology
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Question 29
Incorrect
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Which option is considered to have the lowest risk of causing damage to the heart?
Your Answer:
Correct Answer: Lofepramine
Explanation:Among the tricyclic antidepressants, Lofepramine has the lowest potential for causing cardiotoxicity.
Antidepressants and Their Cardiac Effects
SSRIs are generally recommended for patients with cardiac disease as they may protect against myocardial infarction (MI). Untreated depression worsens prognosis in cardiovascular disease. Post MI, SSRIs and mirtazapine have either a neutral of beneficial effect on mortality. Sertraline is recommended post MI, but other SSRIs and mirtazapine are also likely to be safe. However, citalopram is associated with Torsades de pointes (mainly in overdose). Bupropion, citalopram, escitalopram, moclobemide, lofepramine, and venlafaxine should be used with caution of avoided in those at risk of serious arrhythmia (those with heart failure, left ventricular hypertrophy, previous arrhythmia, of MI).
Tricyclic antidepressants (TCAs) have established arrhythmogenic activity which arises as a result of potent blockade of cardiac sodium channels and variable activity at potassium channels. ECG changes produced include PR, QRS, and QT prolongation and the Brugada syndrome. Lofepramine is less cardiotoxic than other TCAs and seems to lack the overdose arrhythmogenicity of other TCAs. QT changes are not usually seen at normal clinical doses of antidepressants (but can occur, particularly with citalopram/escitalopram). The arrhythmogenic potential of TCAs and other antidepressants is dose-related.
Overall, SSRIs are recommended for patients with cardiac disease, while caution should be exercised when prescribing TCAs and other antidepressants, especially in those at risk of serious arrhythmia. It is important to monitor patients closely for any cardiac effects when prescribing antidepressants.
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This question is part of the following fields:
- Psychopharmacology
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Question 30
Incorrect
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Which language assessment is considered a neuropsychological test?
Your Answer:
Correct Answer: Token test
Explanation:The neuropsychological assessment includes the token test, which is a language test that uses various tokens, such as differently coloured rectangles and circular discs. The subject is given verbal instructions of increasing complexity to perform tasks with these tokens, and it is a sensitive measure of language comprehension impairment, particularly in cases of aphasia. Additionally, there are several tests of executive function that assess frontal lobe function, including the Stroop test, Tower of London test, Wisconsin card sorting test, Cognitive estimates test, Six elements test, Multiple errands task, and Trails making test.
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This question is part of the following fields:
- Neurosciences
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