00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - What is the way in which reboxetine works? ...

    Correct

    • What is the way in which reboxetine works?

      Your Answer: NRI (noradrenaline reuptake inhibitor)

      Explanation:

      Reboxetine is classified as a selective inhibitor of noradrenaline reuptake (NRI), which means it works by preventing the reuptake of noradrenaline and increasing its levels in the body. This medication is typically prescribed as a secondary option for treating acute depressive episodes of major depression when SSRIs are ineffective of not well-tolerated.

    • This question is part of the following fields:

      • Psychopharmacology
      4.4
      Seconds
  • Question 2 - What is a true statement about the cerebellum? ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Neurosciences
      30.4
      Seconds
  • Question 3 - Which antipsychotic is most strongly linked to sudden death? ...

    Correct

    • Which antipsychotic is most strongly linked to sudden death?

      Your Answer: Thioridazine

      Explanation:

      Antipsychotics and Sudden Death: Thioridazine and QTc Prolongation

      Antipsychotic medications are known to carry a risk of sudden death, particularly due to their effects on cardiac function. Thioridazine, in particular, has been found to have pronounced effects on potassium channels and significantly prolongs the QTc interval, which is a measure of the time it takes for the heart to repolarize after each beat. This prolongation can lead to a potentially fatal arrhythmia known as torsades de pointes. As a result, thioridazine is most strongly associated with sudden death among antipsychotics.

      However, all antipsychotics carry some degree of risk for QTc prolongation and should be closely monitored for changes in this interval. This is especially important for patients with preexisting cardiac conditions of other risk factors for arrhythmias. Regular electrocardiogram (ECG) monitoring may be necessary to detect any changes in QTc interval and adjust medication accordingly. By carefully monitoring patients and taking appropriate precautions, healthcare providers can help minimize the risk of sudden death associated with antipsychotic use.

    • This question is part of the following fields:

      • Psychopharmacology
      4.4
      Seconds
  • Question 4 - What stage of sleep do most adults spend the majority of their time...

    Correct

    • What stage of sleep do most adults spend the majority of their time in during the night?

      Your Answer: Stage 2

      Explanation:

      – Dement and Kleitman (1957) classified sleep into five stages.
      – Normal adults spend the majority of their sleep in Stage 2 (55%).
      – Non-REM sleep is divided into four stages: Stage 1 (5%), Stage 2 (55%), Stage 3 (5%), and Stage 4 (10%).
      – REM sleep is Stage 5 and normal adults spend 25% of their sleep in this stage.

    • This question is part of the following fields:

      • Neurosciences
      7
      Seconds
  • Question 5 - What is a true statement about placebos? ...

    Correct

    • What is a true statement about placebos?

      Your Answer: Placebo induced analgesia can be blocked by naloxone

      Explanation:

      Placebos that are inert can still cause negative effects.

      Understanding the Placebo Effect

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

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

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

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

    • This question is part of the following fields:

      • Classification And Assessment
      19.6
      Seconds
  • Question 6 - What cognitive process is responsible for handling information related to the position of...

    Correct

    • What cognitive process is responsible for handling information related to the position of velocity of an object in space?

      Your Answer: Visuospatial Sketch Pad

      Explanation:

      Memory Forms

      Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.

      Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).

      Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.

      Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).

      Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.

    • This question is part of the following fields:

      • Social Psychology
      30.3
      Seconds
  • Question 7 - What neurotransmitter is recognized for its significant role in triggering hunger? ...

    Incorrect

    • What neurotransmitter is recognized for its significant role in triggering hunger?

      Your Answer: Glutamate

      Correct Answer: Orexin

      Explanation:

      Neurotransmitters and their functions:

      Orexin, which is derived from the Greek word for ‘appetite’, is responsible for regulating arousal, wakefulness, and appetite. It is also known as hypocretin and is produced in the hypothalamus. Orexin increases the craving for food.

      Glutamate is an excitatory amino acid that plays a crucial role in the nervous system. It is responsible for transmitting signals between nerve cells and is involved in learning and memory.

      Prolactin is a neurotransmitter produced by the hypothalamus. It is also known as ‘dopamine inhibitory factor’ and is important in the regulation of sexual function. Prolactin levels increase during pregnancy and breastfeeding.

      Serotonin is a monoamine neurotransmitter that has a range of actions, including decreasing appetite. It is involved in regulating mood, sleep, and appetite. Low levels of serotonin have been linked to depression and anxiety.

    • This question is part of the following fields:

      • Neurosciences
      20.9
      Seconds
  • Question 8 - What is the probable identity of the drug used in the treatment arm...

    Correct

    • What is the probable identity of the drug used in the treatment arm of the clinical trial for schizophrenia that showed a statistically significant reduction in negative symptoms as measured by PANSS?

      Your Answer: Minocycline

      Explanation:

      The effectiveness of minocycline, a tetracycline antibiotic, in providing neuroprotection has been observed in vitro. This study aimed to evaluate the impact of minocycline on negative symptoms in individuals diagnosed with schizophrenia at the beginning of the trial and after one year of follow-up. Minocycline is recognized for its ability to be well-tolerated in acne treatment and its capacity to cross the blood-brain barrier. Preliminary findings have indicated that it may be effective in preventing the onset of negative symptoms in schizophrenia. There have been no clinical trials conducted on the other antibiotics.

    • This question is part of the following fields:

      • Psychopharmacology
      11.5
      Seconds
  • Question 9 - What is the recommended course of treatment for a man who experiences depression...

    Correct

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

      Your Answer: Sertraline

      Explanation:

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

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

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

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

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

    • This question is part of the following fields:

      • Psychopharmacology
      23.9
      Seconds
  • Question 10 - What is the typical number of autosomes found in a human somatic cell?...

    Incorrect

    • What is the typical number of autosomes found in a human somatic cell?

      Your Answer: 46

      Correct Answer: 44

      Explanation:

      Aneuploidy: Abnormal Chromosome Numbers

      Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.

      Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.

      The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.

    • This question is part of the following fields:

      • Genetics
      3.9
      Seconds
  • Question 11 - A 35 year old woman has been referred to your clinic with suspected...

    Correct

    • A 35 year old woman has been referred to your clinic with suspected functional paralysis of the left leg. When you ask her to raise her unaffected leg while lying flat on the bed, you feel her pushing down on your hand as you place it under her affected leg.
      What sign has been demonstrated?

      Your Answer: Hoover's sign

      Explanation:

      – A Battle’s sign is a physical indication of a basal skull fracture.
      – Babinski’s sign is a clinical sign that suggests an upper motor neuron lesion.
      – Kernig’s sign is a clinical sign that indicates meningeal irritation.
      – Russell’s sign is characterized by scarring on the knuckles and back of the hand, and it is indicative of repeated induced vomiting.

      Hoover’s Sign for Differentiating Organic and Functional Weakness

      Functional weakness refers to weakness that is inconsistent with any identifiable neurological disease and may be diagnosed as conversion disorder of dissociative motor disorder. To differentiate between organic and functional weakness of pyramidal origin, Dr. Charles Franklin Hoover described Hoover’s sign over 100 years ago.

      This test is typically performed on the lower limbs and is useful when the nature of hemiparesis is uncertain. When a person with organic hemiparesis is asked to flex the hip of their normal leg against resistance, they will not exert pressure on the examiner’s hand placed under the heel on the affected side. However, in hysterical weakness, the examiner will feel increased pressure on their hand. Hoover’s sign is a valuable tool for distinguishing between organic and functional weakness.

    • This question is part of the following fields:

      • Neurosciences
      8.6
      Seconds
  • Question 12 - Which of the following symptoms is classified as negative according to the PANSS...

    Incorrect

    • Which of the following symptoms is classified as negative according to the PANSS coding system?

      Your Answer: Disturbance of volition

      Correct Answer: Stereotyped thinking

      Explanation:

      The Positive and Negative Syndrome Scale (PANSS) is a tool used to measure the severity of symptoms in patients with schizophrenia. The scale is divided into three categories: positive symptoms, negative symptoms, and general psychopathology symptoms. Each category has several items that are scored on a seven-point severity scale. The positive symptoms include delusions, hallucinations, and hyperactivity, while the negative symptoms include blunted affect and lack of spontaneity. The general psychopathology symptoms include anxiety, depression, and poor impulse control. The PANSS is a valuable tool for clinicians to assess the severity of symptoms in patients with schizophrenia and to monitor their progress over time.

    • This question is part of the following fields:

      • Classification And Assessment
      49.2
      Seconds
  • Question 13 - What is a true statement about the cytochrome P450 system? ...

    Incorrect

    • What is a true statement about the cytochrome P450 system?

      Your Answer: The CYP2D subfamily is the most abundant

      Correct Answer: CYP2D6 shows the largest phenotypic variation amongst the cytochromes

      Explanation:

      The liver plays a significant role in breaking down clozapine through the action of CYP450 enzymes, with CYP1A2, CYP3A4, and CYP2D6 being particularly involved in the process.

      The Cytochrome P450 system is a group of enzymes that metabolize drugs by altering their functional groups. The system is located in the liver and small intestine and is involved in drug interactions through enzyme induction of inhibition. Notable inducers include smoking, alcohol, and St John’s Wort, while notable inhibitors include grapefruit juice and some SSRIs. CYP2D6 is important due to genetic polymorphism, and CYP3A4 is the most abundant subfamily and is commonly involved in interactions. Grapefruit juice inhibits both CYP1A2 and CYP3A4, while tobacco smoking induces CYP1A2. The table summarizes the main substrates, inhibitors, and inducers for each CYP enzyme.

    • This question is part of the following fields:

      • Psychopharmacology
      17.7
      Seconds
  • Question 14 - Which benzodiazepine has the shortest half-life? ...

    Incorrect

    • Which benzodiazepine has the shortest half-life?

      Your Answer: Temazepam

      Correct Answer: Zopiclone

      Explanation:

      The half-lives of benzodiazepines that are important to keep in mind are as follows: Diazepam has a half-life of 20-100 hours (with an active metabolite half-life of 36-200 hours), Lorazepam has a half-life of 10-20 hours, Chlordiazepoxide has a half-life of 5-30 hours (with an active metabolite half-life of 36-200 hours), and Nitrazepam has a half-life of 15-38 hours.

      The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.

    • This question is part of the following fields:

      • Psychopharmacology
      12.5
      Seconds
  • Question 15 - What is a true statement about cerebrovascular accidents? ...

    Incorrect

    • What is a true statement about cerebrovascular accidents?

      Your Answer: MRI is the investigation of choice during the first 48 hours after a stroke

      Correct Answer: Cerebral infarction commonly occurs during sleep

      Explanation:

      It is widely acknowledged that women who have pre-existing cardiovascular disease should avoid taking oral contraceptives due to the increased risk of stroke and DVTs.

      Cerebrovascular accidents (CVA), also known as strokes, are defined by the World Health Organization as a sudden onset of focal neurological symptoms lasting more than 24 hours and presumed to be of vascular origin. Strokes can be caused by either infarction of hemorrhage, with infarction being more common. Hemorrhagic strokes tend to be more severe. Intracranial hemorrhage can be primary, caused mainly by hypertension, of subarachnoid, caused by the rupture of an aneurysm of angioma. Primary intracranial hemorrhage is most common in individuals aged 60-80 and often occurs during exertion. Infarction can be caused by thrombosis of embolism, with thrombosis being more common. Atherosclerosis, often caused by hypertension, is the main cause of infarction. CT scanning is the preferred diagnostic tool during the first 48 hours after a stroke as it can distinguish between infarcts and hemorrhages. Recovery from embolism is generally quicker and more complete than from thrombosis due to the availability of collateral channels.

    • This question is part of the following fields:

      • Neurosciences
      42.1
      Seconds
  • Question 16 - What is the structure that divides which parts of the brain? ...

    Incorrect

    • What is the structure that divides which parts of the brain?

      Your Answer: The cerebellar hemispheres

      Correct Answer: The lateral ventricles

      Explanation:

      The septum pellucidum is a thin layer that divides the front sections of the left and right lateral ventricles in the brain. It extends as a flat structure from the corpus callosum to the fornix.

      Dementia Pugilistica: A Neurodegenerative Condition Resulting from Neurotrauma

      Dementia pugilistica, also known as chronic traumatic encephalopathy (CTE), is a neurodegenerative condition that results from neurotrauma. It is commonly seen in boxers and NFL players, but can also occur in anyone with neurotrauma. The condition is characterized by symptoms such as gait ataxia, slurred speech, impaired hearing, tremors, disequilibrium, neurobehavioral disturbances, and progressive cognitive decline.

      Most cases of dementia pugilistica present with early onset cognitive deficits, and behavioral signs exhibited by patients include aggression, suspiciousness, paranoia, childishness, hypersexuality, depression, and restlessness. The progression of the condition leads to more prominent behavioral symptoms such as difficulty with impulse control, irritability, inappropriateness, and explosive outbursts of aggression.

      Neuropathological abnormalities have been identified in CTE, with the most unique feature being the abnormal accumulation of tau in neurons and glia in an irregular, focal, perivascular distribution and at the depths of cortical sulci. Abnormalities of the septum pellucidum, such as cavum and fenestration, are also a common feature.

      While the condition has become increasingly rare due to the progressive improvement in sports safety, it is important to recognize the potential long-term consequences of repeated head injuries and take steps to prevent them.

    • This question is part of the following fields:

      • Neurosciences
      4.2
      Seconds
  • Question 17 - Among the given medications, which one is the most probable cause of delirium?...

    Correct

    • Among the given medications, which one is the most probable cause of delirium?

      Your Answer: Pethidine

      Explanation:

      Prescribing in the Elderly: Iatrogenic Consequences

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

      Medications Linked to Delirium and Other Cognitive Disorders

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

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

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

      Medications Linked to Mood Changes

      The following medications are well known to precipitate mood changes:

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

      Medications Linked to Psychosis

      The following medications are well known to precipitate psychosis:

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

      Medications Linked to Anxiety

      The following medications are well known to precipitate anxiety:

      – Stimulants
      – β adrenergic inhalers

    • This question is part of the following fields:

      • Psychopharmacology
      3.8
      Seconds
  • Question 18 - Research has suggested that dysfunction of oligodendrocytes and the myelin sheath may play...

    Correct

    • Research has suggested that dysfunction of oligodendrocytes and the myelin sheath may play a role in the development of schizophrenia. Can you provide information on the function of the myelin sheath in the nervous system?

      Your Answer: Increases the transmission of electrochemical impulses

      Explanation:

      Myelin sheaths are composed of cells containing fat that act as insulation for the axons of neurons. These cells run along the axons with gaps between them called nodes of Ranvier. The fat in the myelin sheath makes it a poor conductor, causing impulses to jump from one gap to the next, which increases the speed of transmission of action potentials.

      The white matter of the brain gets its whitish appearance from the myelin sheath, which is made up of glial cells. Oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system are responsible for forming the myelin sheath. The electrical impulse jumps from one node to the next at a rapid rate of up to 120 meters per second, which is known as saltatory conduction.

      Glycoproteins play a crucial role in the formation, maintenance, and degradation of myelin sheaths. Recent studies suggest that dysfunction in oligodendrocytes and myelin can lead to changes in synaptic formation and function, resulting in cognitive dysfunction, a core symptom of schizophrenia. Additionally, there is evidence linking oligodendrocyte and myelin dysfunction with abnormalities in dopamine and glutamate, both of which are found in schizophrenia. Addressing these abnormalities could offer therapeutic opportunities for individuals with schizophrenia.

    • This question is part of the following fields:

      • Neurosciences
      21.7
      Seconds
  • Question 19 - What is a pathological characteristic observed in individuals with Alzheimer's disease? ...

    Correct

    • What is a pathological characteristic observed in individuals with Alzheimer's disease?

      Your Answer: Hyperphosphorylated tau

      Explanation:

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

    • This question is part of the following fields:

      • Neurosciences
      9.9
      Seconds
  • Question 20 - To which category does the dentate gyrus belong? ...

    Correct

    • To which category does the dentate gyrus belong?

      Your Answer: Hippocampus

      Explanation:

      The dentate gyrus is a component of the hippocampal formation.

      A gyrus is a ridge on the cerebral cortex, and there are several important gyri to be aware of in exams. These include the angular gyrus in the parietal lobe for language, mathematics, and cognition; the cingulate gyrus adjacent to the corpus callosum for emotion, learning, and memory; the fusiform gyrus in the temporal lobe for face and body recognition, as well as word and number recognition; the precentral gyrus in the frontal lobe for voluntary movement control; the postcentral gyrus in the parietal lobe for touch; the lingual gyrus in the occipital lobe for dreaming and word recognition; the superior frontal gyrus in the frontal lobe for laughter and self-awareness; the superior temporal gyrus in the temporal lobe for language and sensation of sound; the parahippocampal gyrus surrounding the hippocampus for memory; and the dentate gyrus in the hippocampus for the formation of episodic memory.

    • This question is part of the following fields:

      • Neurosciences
      43.2
      Seconds
  • Question 21 - Which statement accurately describes the role of the basal ganglia? ...

    Correct

    • Which statement accurately describes the role of the basal ganglia?

      Your Answer: Degeneration of the basal ganglia is associated with movement problems

      Explanation:

      The Basal Ganglia: Functions and Disorders

      The basal ganglia are a group of subcortical structures that play a crucial role in controlling movement and some cognitive processes. The components of the basal ganglia include the striatum (caudate, putamen, nucleus accumbens), subthalamic nucleus, globus pallidus, and substantia nigra (divided into pars compacta and pars reticulata). The putamen and globus pallidus are collectively referred to as the lenticular nucleus.

      The basal ganglia are connected in a complex loop, with the cortex projecting to the striatum, the striatum to the internal segment of the globus pallidus, the internal segment of the globus pallidus to the thalamus, and the thalamus back to the cortex. This loop is responsible for regulating movement and cognitive processes.

      However, problems with the basal ganglia can lead to several conditions. Huntington’s chorea is caused by degeneration of the caudate nucleus, while Wilson’s disease is characterized by copper deposition in the basal ganglia. Parkinson’s disease is associated with degeneration of the substantia nigra, and hemiballism results from damage to the subthalamic nucleus.

      In summary, the basal ganglia are a crucial part of the brain that regulate movement and some cognitive processes. Disorders of the basal ganglia can lead to significant neurological conditions that affect movement and other functions.

    • This question is part of the following fields:

      • Neurosciences
      43.7
      Seconds
  • Question 22 - What type of antidepressant is classified as specific for noradrenaline and serotonin? ...

    Correct

    • What type of antidepressant is classified as specific for noradrenaline and serotonin?

      Your Answer: Mirtazapine

      Explanation:

      Antidepressants: Mechanism of Action

      Antidepressants are a class of drugs used to treat depression and other mood disorders. The mechanism of action of antidepressants varies depending on the specific drug. Here are some examples:

      Mirtazapine is a noradrenaline and serotonin specific antidepressant (NaSSa). It works by blocking certain receptors in the brain, including 5HT-1, 5HT-2, 5HT-3, and H1 receptors. It also acts as a presynaptic alpha 2 antagonist, which stimulates the release of noradrenaline and serotonin.

      Venlafaxine and duloxetine are both serotonin and noradrenaline reuptake inhibitors (SNRIs). They work by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.

      Reboxetine is a noradrenaline reuptake inhibitor (NRI). It works by blocking the reuptake of noradrenaline, which increases its availability in the brain.

      Bupropion is a noradrenaline and dopamine reuptake inhibitor (NDRI). It works by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.

      Trazodone is a weak serotonin reuptake inhibitor (SRI) and 5HT agonist. It works by increasing the availability of serotonin in the brain.

      St John’s Wort is a natural supplement that has been used to treat depression. It has a weak monoamine oxidase inhibitor (MAOI) effect and a weak SNRI effect.

      In summary, antidepressants work by increasing the availability of certain neurotransmitters in the brain, such as serotonin, noradrenaline, and dopamine. The specific mechanism of action varies depending on the drug.

    • This question is part of the following fields:

      • Psychopharmacology
      28.4
      Seconds
  • Question 23 - A 30-year-old woman tells her husband that she feels like she's being watched...

    Incorrect

    • A 30-year-old woman tells her husband that she feels like she's being watched constantly. She believes that she can hear people talking about her from their workplace (which is located a mile away).
      What perceptual abnormality is she likely experiencing?

      Your Answer: Autoscopic hallucination

      Correct Answer: Extracampine hallucination

      Explanation:

      Extracampine hallucinations refer to hallucinations that occur beyond one’s sensory range, such as outside the visual of auditory field. Functional hallucinations require an external stimulus to trigger them, but the individual experiences both the normal perception of the stimulus and the hallucination simultaneously. Reflex hallucinations occur when a stimulus in one modality leads to a hallucination in another modality. Hypnagogic hallucinations occur during the process of falling asleep, while autoscopic hallucinations involve abnormal visual perception of oneself.

    • This question is part of the following fields:

      • Descriptive Psychopathology
      19.8
      Seconds
  • Question 24 - An elderly woman attempts to light herself on fire to demonstrate to her...

    Correct

    • An elderly woman attempts to light herself on fire to demonstrate to her therapist that she has already passed away. What type of delusion is this an example of?

      Your Answer: Cotard's syndrome

      Explanation:

      Types of Delusions

      Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:

      – Folie a deux: a shared delusion between two or more people
      – Grandiose: belief that one has special powers, beliefs, of purpose
      – Hypochondriacal: belief that something is physically wrong with the patient
      – Ekbom’s syndrome: belief that one has been infested with insects
      – Othello syndrome: belief that a sexual partner is cheating on them
      – Capgras delusion: belief that a person close to them has been replaced by a double
      – Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
      – Syndrome of subjective doubles: belief that doubles of him/her exist
      – Lycanthropy: belief that one has been transformed into an animal
      – De Clérambault’s syndrome: false belief that a person is in love with them
      – Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
      – Referential: belief that others/TV/radio are speaking directly to of about the patient
      – Delusional perception: belief that a normal percept (product of perception) has a special meaning
      – Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.

      Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.

    • This question is part of the following fields:

      • Classification And Assessment
      20.8
      Seconds
  • Question 25 - Which cognitive function is primarily assessed by the intersecting pentagons task in the...

    Correct

    • Which cognitive function is primarily assessed by the intersecting pentagons task in the MMSE?

      Your Answer: Constructional praxis

      Explanation:

      Mini Mental State Exam (MMSE)

      The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.

    • This question is part of the following fields:

      • Classification And Assessment
      18
      Seconds
  • Question 26 - Which antidepressant is most commonly linked to neutropenia? ...

    Incorrect

    • Which antidepressant is most commonly linked to neutropenia?

      Your Answer: Venlafaxine

      Correct Answer: Mirtazapine

      Explanation:

      Sertraline use has been linked to the development of leucopenia. Patients are advised to report any signs of infection, such as fever, sore throat, of stomatitis, during treatment.

    • This question is part of the following fields:

      • Psychopharmacology
      6.8
      Seconds
  • Question 27 - What type of speech disorder is commonly associated with spasticity and would be...

    Correct

    • What type of speech disorder is commonly associated with spasticity and would be most likely to be observed in a patient?

      Your Answer: Pseudobulbar palsy

      Explanation:

      Dysarthria is a speech disorder that affects the volume, rate, tone, of quality of spoken language. There are different types of dysarthria, each with its own set of features, associated conditions, and localisation. The types of dysarthria include spastic, flaccid, hypokinetic, hyperkinetic, and ataxic.

      Spastic dysarthria is characterised by explosive and forceful speech at a slow rate and is associated with conditions such as pseudobulbar palsy and spastic hemiplegia.

      Flaccid dysarthria, on the other hand, is characterised by a breathy, nasal voice and imprecise consonants and is associated with conditions such as myasthenia gravis.

      Hypokinetic dysarthria is characterised by slow, quiet speech with a tremor and is associated with conditions such as Parkinson’s disease.

      Hyperkinetic dysarthria is characterised by a variable rate, inappropriate stoppages, and a strained quality and is associated with conditions such as Huntington’s disease, Sydenham’s chorea, and tardive dyskinesia.

      Finally, ataxic dysarthria is characterised by rapid, monopitched, and slurred speech and is associated with conditions such as Friedreich’s ataxia and alcohol abuse. The localisation of each type of dysarthria varies, with spastic and flaccid dysarthria affecting the upper and lower motor neurons, respectively, and hypokinetic, hyperkinetic, and ataxic dysarthria affecting the extrapyramidal and cerebellar regions of the brain.

    • This question is part of the following fields:

      • Neurosciences
      19.6
      Seconds
  • Question 28 - What type of memory is demonstrated when an individual can recall a phone...

    Correct

    • What type of memory is demonstrated when an individual can recall a phone number from a directory and dial it accurately without writing it down?

      Your Answer: Working

      Explanation:

      The term ‘short-term memory’ is a less advanced term compared to ‘working memory’.

      Memory Forms

      Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.

      Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).

      Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.

      Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).

      Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.

    • This question is part of the following fields:

      • Social Psychology
      11.4
      Seconds
  • Question 29 - What is the association with theta rhythms? ...

    Correct

    • What is the association with theta rhythms?

      Your Answer: Seen in meditative practice

      Explanation:

      Electroencephalography

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

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

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

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

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

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

    • This question is part of the following fields:

      • Neurosciences
      8.2
      Seconds
  • Question 30 - Which statement accurately describes sporadic CJD? ...

    Incorrect

    • Which statement accurately describes sporadic CJD?

      Your Answer: It is associated with the pulvinar sign on the MRI

      Correct Answer: It tends to affect older rather than younger people

      Explanation:

      Variant CJD primarily affects younger individuals, while sporadic CJD is more commonly seen in older individuals.

      Creutzfeldt-Jakob Disease: Differences between vCJD and CJD

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

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

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

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

    • This question is part of the following fields:

      • Neurosciences
      7.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Psychopharmacology (6/9) 67%
Neurosciences (9/13) 69%
Classification And Assessment (3/4) 75%
Social Psychology (2/2) 100%
Genetics (0/1) 0%
Descriptive Psychopathology (0/1) 0%
Passmed