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  • Question 1 - A patient in her 60s with psoriasis has observed that her condition has...

    Correct

    • A patient in her 60s with psoriasis has observed that her condition has deteriorated since commencing a new medication. What factor would you suspect to be the most likely cause of exacerbating her psoriasis?

      Your Answer: Lithium

      Explanation:

      Medications that can exacerbate psoriasis symptoms include:
      – Lithium
      – Selective serotonin reuptake inhibitors (SSRIs)
      – Beta blockers
      – Angiotensin-converting enzyme (ACE) inhibitors

      Lithium – Pharmacology

      Pharmacokinetics:
      Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

      Ebstein’s:
      Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

      Contraindications:
      Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

      Side-effects:
      Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

      Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

      Lithium-induced diabetes insipidus:
      Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

      Toxicity:
      Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

      Pre-prescribing:
      Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Monitoring:
      Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 2 - What factor increases the risk of developing neuroleptic malignant syndrome? ...

    Correct

    • What factor increases the risk of developing neuroleptic malignant syndrome?

      Your Answer: Having Parkinson's disease

      Explanation:

      The use of dopaminergic drugs in individuals with Parkinson’s disease increases their susceptibility to NMS. NMS is more likely to develop when there is a modification in the dosage of dopaminergic and antipsychotic medications. While it is possible, NMS does not typically arise without the administration of dopamine-affecting drugs.

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

    • This question is part of the following fields:

      • Psychopharmacology
      11.4
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  • Question 3 - What methods are used to generate estimates of white matter tracts? ...

    Correct

    • What methods are used to generate estimates of white matter tracts?

      Your Answer: DTI

      Explanation:

      Neuroimaging techniques can be divided into structural and functional types, although this distinction is becoming less clear as new techniques emerge. Structural techniques include computed tomography (CT) and magnetic resonance imaging (MRI), which use x-rays and magnetic fields, respectively, to produce images of the brain’s structure. Functional techniques, on the other hand, measure brain activity by detecting changes in blood flow of oxygen consumption. These include functional MRI (fMRI), emission tomography (PET and SPECT), perfusion MRI (pMRI), and magnetic resonance spectroscopy (MRS). Some techniques, such as diffusion tensor imaging (DTI), combine both structural and functional information to provide a more complete picture of the brain’s anatomy and function. DTI, for example, uses MRI to estimate the paths that water takes as it diffuses through white matter, allowing researchers to visualize white matter tracts.

    • This question is part of the following fields:

      • Neurosciences
      9.3
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  • Question 4 - How is clinical research currently guided worldwide in terms of ethical recommendations? ...

    Incorrect

    • How is clinical research currently guided worldwide in terms of ethical recommendations?

      Your Answer: Nuremburg Code

      Correct Answer: Helsinki declaration

      Explanation:

      The Significance of the Declaration of Helsinki in Biomedical Research Ethics

      The Declaration of Helsinki, created by the World Medical Association in 1964, outlines the fundamental ethical principles that govern biomedical research involving human subjects. Over the years, it has undergone several revisions and continues to serve as a cornerstone of good medical practice. Its importance lies in its ability to provide a framework for ethical decision-making in research, ensuring that the rights, safety, and well-being of human subjects are protected. The Declaration of Helsinki is a crucial document that guides researchers, clinicians, and policymakers in their efforts to conduct ethical and responsible research.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 5 - Which individual in the New York Longitudinal Study categorized children's interactions with their...

    Correct

    • Which individual in the New York Longitudinal Study categorized children's interactions with their parents into three distinct groups (easy child, difficult child, and slow-to-warm-up child)?

      Your Answer: Thomas and Chess

      Explanation:

      While Mary Rothbart, Rudolf Steiner, and Jerome Kagan are known for their theories on the stability of personality traits in children, they were not involved in the New York Longitudinal Study conducted in the 1970s. However, Solomon Diamond, who focused on personality and temperament and conducted research on various animal studies, is also associated with this field.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 6 - Based on the ÆSOP study, what is the most influential factor in determining...

    Correct

    • Based on the ÆSOP study, what is the most influential factor in determining a prolonged period of untreated psychosis (DUP)?

      Your Answer: Insidious onset

      Explanation:

      The variable with the strongest effect on DUP was not unemployment, but rather family involvement in help seeking. Additionally, an acute onset was associated with a shorter DUP compared to an insidious onset, and affective psychosis was associated with a shorter DUP than non-affective psychosis. However, unemployment was still found to be associated with a longer DUP. These findings were from the ÆSOP study, which included all patients with a first episode of psychosis who made contact with psychiatric services over a two year period and were living in defined catchment areas in London and Nottingham, UK.

    • This question is part of the following fields:

      • Epidemiology
      13.9
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  • Question 7 - What illness is brought about by prions? ...

    Correct

    • What illness is brought about by prions?

      Your Answer: Creutzfeldt-Jakob disease

      Explanation:

      Prions are responsible for causing Creutzfeldt-Jakob disease (CJD), a fatal and uncommon condition that leads to progressive neurodegeneration. The disease is characterized by swiftly advancing dementia as one of its primary symptoms.

    • This question is part of the following fields:

      • Neurosciences
      8.1
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  • Question 8 - A client complains of feeling ill after abruptly discontinuing paroxetine. What symptom is...

    Correct

    • A client complains of feeling ill after abruptly discontinuing paroxetine. What symptom is most indicative of discontinuation syndrome associated with selective serotonin reuptake inhibitors?

      Your Answer: Shock-like sensations

      Explanation:

      Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 9 - A 62-year-old woman is referred to your clinic.
    Her daughter has noticed a progressive...

    Incorrect

    • A 62-year-old woman is referred to your clinic.
      Her daughter has noticed a progressive behavioural change in her mother. She is more aggressive whilst demanding attention. She giggles uncontrollably for no apparent reason, and has been seen wandering outside their house without proper clothing. She has also become more forgetful over the last six months.
      She is physically well and has no problems with her heart, blood pressure of diabetes. She is on no medication. You conduct cognitive testing and refer the woman for an EEG.
      What is the most probable EEG finding?

      Your Answer:

      Correct Answer: Normal EEG

      Explanation:

      The individual’s age, behavioral changes, disinhibition, and fatuous giggling suggest a diagnosis of frontal lobe dementia, which is further supported by their physical examination. The absence of focal abnormalities on EEG rules out the possibility of vascular dementia. Typically, EEG results are normal during the early stages of this condition and remain so until the advanced stages.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 10 - What is the drug that primarily acts through the GABA system? ...

    Incorrect

    • What is the drug that primarily acts through the GABA system?

      Your Answer:

      Correct Answer: Sodium valproate

      Explanation:

      Mechanisms of Action of Different Drugs

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 11 - What neuroimaging result is typically seen in individuals diagnosed with obsessive compulsive disorder?...

    Incorrect

    • What neuroimaging result is typically seen in individuals diagnosed with obsessive compulsive disorder?

      Your Answer:

      Correct Answer: Hypermetabolism of orbitofrontal area

      Explanation:

      This question is a common one, but it is worded in various ways each time.

      Neuroimaging Findings in Obsessive-Compulsive Disorder (OCD)

      Obsessive-compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Neuroimaging studies have been conducted to investigate the underlying neural mechanisms of OCD. Two commonly used techniques are 18 Fluorodeoxyglucose PET (FDG-PET) and Technetium-99m (99mTc)-hexamethylpropyleneamine-oxime SPECT (HMPAO-SPECT).

      Studies using FDG-PET have reported increased glucose metabolism in several brain regions among OCD patients, including the orbitofrontal cortex (OFC), caudate, thalamus, prefrontal cortex, and anterior cingulate. These regions are involved in cognitive and emotional processing, decision-making, and motor control. The increased activity in these regions may contribute to the symptoms of OCD, such as repetitive behaviors and difficulty controlling intrusive thoughts.

      On the other hand, studies using HMPAO-SPECT have found both increased and decreased blood flow to various brain regions in OCD patients compared to normal controls. These regions include the OFC, caudate, various areas of the cortex, and thalamus. The inconsistent findings may be due to differences in the severity and subtype of OCD, as well as the specific task of stimulus used in the imaging studies.

      Overall, neuroimaging studies have provided valuable insights into the neural mechanisms of OCD. However, further research is needed to better understand the complex interactions between different brain regions and how they contribute to the development and maintenance of OCD symptoms.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 12 - You are on call for a general medical ward and are asked to...

    Incorrect

    • You are on call for a general medical ward and are asked to evaluate a 45-year-old woman who has been experiencing intermittent confusion and aggression for the past three days. She recently recovered from a severe respiratory infection but has been experiencing 20-minute periods of lucidity and confusion, preceded by abdominal discomfort. There is no history of substance abuse of alcohol dependence, and all blood and urine tests have come back negative. A CT scan of her brain is normal, and she has not been taking her prescribed medication during her hospital stay. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Temporal lobe epilepsy

      Explanation:

      Differential Diagnosis for a Patient with Temporal Lobe Epilepsy

      Temporal lobe epilepsy, also known as complex partial seizures, is characterized by an aura of abdominal symptoms followed by altered consciousness and behavior. This episodic condition can occur rapidly. The presenting symptoms of this patient suggest an acute confusional state, ruling out antibiotic-induced psychosis, which is associated with ongoing antibiotic treatment. Delirium tremens, a severe form of alcohol withdrawal, is also unlikely. Early onset dementia cannot be associated with this presentation due to insufficient information. A differential diagnosis is necessary to determine the underlying cause of the patient’s symptoms.

    • This question is part of the following fields:

      • Diagnosis
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  • Question 13 - What substance do bodybuilders misuse in order to increase their overall body mass?...

    Incorrect

    • What substance do bodybuilders misuse in order to increase their overall body mass?

      Your Answer:

      Correct Answer: Insulin

      Explanation:

      Anabolic Steroids: Uses, Misuse, and Complications

      Anabolic steroids are synthetic derivatives of testosterone that have both anabolic and androgenic properties. They are commonly used by athletes to enhance performance and by individuals to improve physical appearance. However, their misuse is not uncommon, with nearly half of users of dedicated bodybuilding gyms admitting to taking anabolic agents. Misuse can lead to dependence, tolerance, and the development of psychiatric disorders such as aggression, psychosis, mania, and depression/anxiety.

      There are three common regimes practised by steroid misusers: ‘cycling’, ‘stacking’ and ‘pyramiding’. Anabolic steroids can be taken orally, injected intramuscularly, and applied topically in the form of creams and gels. Other drugs are also used by athletes, such as clenbuterol, ephedrine, thyroxine, insulin, tamoxifen, human chorionic Gonadotropin, diuretics, and growth hormone.

      Medical complications are common and can affect various systems, such as the musculoskeletal, cardiovascular, hepatic, reproductive (males and females), dermatological, and other systems. Complications include muscular hypertrophy, increased blood pressure, decreased high-density lipoprotein cholesterol and increased low-density lipoprotein cholesterol, cholestatic jaundice, benign and malignant liver tumours, testicular atrophy, sterility, gynaecomastia, breast tissue shrinkage, menstrual abnormalities, masculinisation, male-pattern baldness, acne, sleep apnoea, exacerbation of tic disorders, polycythaemia, altered immunity, and glucose intolerance.

      Anabolic steroids are a class C controlled drug and can only be obtained legally through a medical prescription. It is important to educate individuals about the risks and complications associated with their misuse and to promote safe and legal use.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 14 - A 35-year-old patient with a history of depression visits her doctor with concerns...

    Incorrect

    • A 35-year-old patient with a history of depression visits her doctor with concerns of decreased energy, difficulty sleeping, and feelings of hopelessness.
      Which self-report questionnaire would be the most suitable for the patient to fill out?

      Your Answer:

      Correct Answer: BDI (Beck depression inventory)

      Explanation:

      The list includes various psychiatric rating scales, with the Beck depression inventory (BDI) being the only self-report tool. It consists of 21 items that evaluate symptoms such as fatigue, irritability, and interest in others, and is designed to measure the severity of depression. On the other hand, the BAS is a clinician-administered scale that assesses medication-induced akathisia, while the BPRS evaluates depression, anxiety, and psychotic symptoms. The HAM-A is a clinician-administered questionnaire that measures the severity of anxiety, and the PANSS is a clinician-administered tool that assesses both positive (hallucinations and delusions) and negative symptoms (social and emotional withdrawal, disordered thinking) in patients with schizophrenia.

    • This question is part of the following fields:

      • Assessment
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  • Question 15 - A 60-year-old man is experiencing severe psychomotor retardation despite being treated with antidepressant...

    Incorrect

    • A 60-year-old man is experiencing severe psychomotor retardation despite being treated with antidepressant medication for his major depressive disorder. What is the correct statement regarding his condition?

      Your Answer:

      Correct Answer: Electroconvulsive therapy (ECT) is likely to improve her mood

      Explanation:

      Patients who do not experience any improvement from antidepressant medication may be recommended to undergo ECT. This is particularly relevant for elderly individuals who commonly experience relapse of depressive symptoms and may also have underlying medical conditions such as Alzheimer’s disease. Additionally, suicide risk in the elderly should be taken seriously and depression should be properly diagnosed and treated.

    • This question is part of the following fields:

      • History And Mental State
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  • Question 16 - What are some common symptoms that are typically observed in the initial phases...

    Incorrect

    • What are some common symptoms that are typically observed in the initial phases of Alzheimer's disease?

      Your Answer:

      Correct Answer: Hippocampal atrophy

      Explanation:

      The medial temporal lobe, comprising the hippocampus and parahippocampal gyrus, exhibits the earliest neuropathological alterations.

      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
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  • Question 17 - What is one of the five major personality traits? ...

    Incorrect

    • What is one of the five major personality traits?

      Your Answer:

      Correct Answer: Neuroticism

      Explanation:

      The Big Five Personality Traits, also known as OCEAN, are five broad categories that can be used to describe an individual’s personality. These categories include Openness to Experience, Conscientiousness, Extraversion (also known as Surgency), Agreeableness, and Neuroticism (also known as Emotional Stability). Each of these traits can be further broken down into specific characteristics that help to define an individual’s personality. For example, Openness to Experience includes traits such as imagination, creativity, and a willingness to try new things. Conscientiousness includes traits such as organization, responsibility, and dependability. Extraversion includes traits such as sociability, assertiveness, and energy level. Agreeableness includes traits such as kindness, empathy, and cooperation. Finally, Neuroticism includes traits such as anxiety, moodiness, and emotional instability. Understanding these personality traits can be helpful in a variety of settings, such as in the workplace of in personal relationships.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 18 - From which structure does the mesolimbic pathway project to the nucleus accumbens? ...

    Incorrect

    • From which structure does the mesolimbic pathway project to the nucleus accumbens?

      Your Answer:

      Correct Answer: Midbrain

      Explanation:

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

    • This question is part of the following fields:

      • Neurosciences
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  • Question 19 - The focus of the Tarasoff case was on which of the following? ...

    Incorrect

    • The focus of the Tarasoff case was on which of the following?

      Your Answer:

      Correct Answer: Duty to warn

      Explanation:

      The therapists in the Tarasoff case were faulted for placing greater importance on maintaining the patient’s confidentiality, thereby prioritizing the principle of beneficence over the rights of the potential victim. As a result, they were deemed to have failed in their duty to consider the principle of non-maleficence.

      Double Agentry in Psychiatry

      Double agentry is a term used to describe a situation where a psychiatrist’s conflict of interest interferes with their ability to act in the best interests of their patient. Psychiatrists often have to balance the interests of multiple parties, such as the patient, family, society, and hospital commissioners, which is known as multiagency.

      The Tarasoff case is a prime example of double agentry in psychiatry. Two therapists failed to warn a woman that their patient had expressed an intention to kill her. They chose not to do so to respect the patient’s confidentiality, but failed to recognize their duty of care to both the patient and the potential victim. Unfortunately, the woman was eventually murdered by the patient.

      This case, which occurred in California, led to a change in the law that now requires therapists to have a legal duty to both their patients and potential victims. It highlights the importance of psychiatrists being aware of their responsibilities to all parties involved and ensuring that they act in the best interests of their patients while also fulfilling their duty of care to others.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 20 - A 72-year-old male reports feeling distressed after hearing his deceased wife's voice in...

    Incorrect

    • A 72-year-old male reports feeling distressed after hearing his deceased wife's voice in his head, asking him to come join her. He clarifies that he heard it internally and not as an external sound. What type of perceptual abnormality is reflected in his experience?

      Your Answer:

      Correct Answer: Pseudohallucinations

      Explanation:

      – Pseudohallucinations are figurative and not real
      – They are located in the inner subjective space
      – Auditory hallucinations are concrete, tangible, and real
      – They are located in the outside objective space
      – Autoscopy is the experience of seeing oneself
      – Reflex hallucination is where a stimulus in one modality produces hallucination in another modality
      – Hypnopompic hallucinations occur when waking up from sleep.

    • This question is part of the following fields:

      • Descriptive Psychopathology
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  • Question 21 - You have a female patient in her 30s who is experiencing depression and...

    Incorrect

    • You have a female patient in her 30s who is experiencing depression and you have recommended antidepressant medication. However, she expresses concern about taking any medication that may impact her sexual functioning. Which antidepressant would be the most appropriate for her in this situation?

      Your Answer:

      Correct Answer: Agomelatine

      Explanation:

      Compared to other antidepressants, agomelatine has a lower likelihood of causing sexual dysfunction. This is because other antidepressants can cause various changes in the body, such as sedation, hormonal changes, and disruption of the cholinergic/adrenergic balance, which can lead to sexual dysfunction. Additionally, other antidepressants may inhibit nitric oxide and increase neurotransmission, which can also contribute to sexual dysfunction. However, agomelatine does not act through the serotonergic of alpha adrenergic systems and has a lower propensity for causing these changes, resulting in less sexual dysfunction.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 22 - Which type of brain lesion is typically associated with Alexia without agraphia? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Posterior cerebral artery

      Explanation:

      Aphasia is a language impairment that affects the production of comprehension of speech, as well as the ability to read of write. The areas involved in language are situated around the Sylvian fissure, referred to as the ‘perisylvian language area’. For repetition, the primary auditory cortex, Wernicke, Broca via the Arcuate fasciculus (AF), Broca recodes into articulatory plan, primary motor cortex, and pyramidal system to cranial nerves are involved. For oral reading, the visual cortex to Wernicke and the same processes as for repetition follows. For writing, Wernicke via AF to premotor cortex for arm and hand, movement planned, sent to motor cortex. The classification of aphasia is complex and imprecise, with the Boston Group classification and Luria’s aphasia interpretation being the most influential. The important subtypes of aphasia include global aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, anomic aphasia, transcortical motor aphasia, and transcortical sensory aphasia. Additional syndromes include alexia without agraphia, alexia with agraphia, and pure word deafness.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 23 - How does varenicline work in the body? ...

    Incorrect

    • How does varenicline work in the body?

      Your Answer:

      Correct Answer: Nicotinic receptor partial agonist

      Explanation:

      Varenicline for Smoking Cessation: Safety and Efficacy

      Varenicline is a medication used to aid smoking cessation by reducing cravings and pleasurable effects of tobacco products. It has a high affinity for the alpha 4 beta 2 nicotinic receptor and is recommended by NICE for smoking cessation. Varenicline is safe to use in cases of liver dysfunction as it undergoes very little hepatic metabolism. It has been found to be nearly 80% more effective than bupropion and more effective than 24-hour nicotine replacement therapy in two large randomized controlled trials. The initial course of treatment could last 12 weeks, with an additional 12 weeks offered to those who have successfully quit smoking. However, varenicline has been observed to exacerbate underlying psychiatric illness, including depression, and is associated with changes in behavior of thinking, anxiety, psychosis, mood swings, aggressive behavior, suicidal ideation, and behavior. Patients with a psychiatric history should be closely monitored while taking varenicline. One randomized controlled trial has challenged this concern. The FDA has issued a safety announcement that varenicline may be associated with a small, increased risk of certain cardiovascular adverse events in patients with cardiovascular disease. The very common side effects of varenicline include nasopharyngitis, abnormal dreams, insomnia, headache, and nausea.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 24 - In which part of the skull is the structure located in the posterior...

    Incorrect

    • In which part of the skull is the structure located in the posterior cranial fossa?

      Your Answer:

      Correct Answer: Foramen magnum

      Explanation:

      The base of the skull contains a sizable opening called the foramen magnum, which permits the spinal cord to pass through.

      Cranial Fossae and Foramina

      The cranium is divided into three regions known as fossae, each housing different cranial lobes. The anterior cranial fossa contains the frontal lobes and includes the frontal and ethmoid bones, as well as the lesser wing of the sphenoid. The middle cranial fossa contains the temporal lobes and includes the greater wing of the sphenoid, sella turcica, and most of the temporal bones. The posterior cranial fossa contains the occipital lobes, cerebellum, and medulla and includes the occipital bone.

      There are several foramina in the skull that allow for the passage of various structures. The most important foramina likely to appear in exams are listed below:

      – Foramen spinosum: located in the middle fossa and allows for the passage of the middle meningeal artery.
      – Foramen ovale: located in the middle fossa and allows for the passage of the mandibular division of the trigeminal nerve.
      – Foramen lacerum: located in the middle fossa and allows for the passage of the small meningeal branches of the ascending pharyngeal artery and emissary veins from the cavernous sinus.
      – Foramen magnum: located in the posterior fossa and allows for the passage of the spinal cord.
      – Jugular foramen: located in the posterior fossa and allows for the passage of cranial nerves IX, X, and XI.

      Understanding the location and function of these foramina is essential for medical professionals, as they play a crucial role in the diagnosis and treatment of various neurological conditions.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 25 - Which of the following antidepressant medications is recognized for having a comparatively elevated...

    Incorrect

    • Which of the following antidepressant medications is recognized for having a comparatively elevated level of toxicity in case of an overdose?

      Your Answer:

      Correct Answer: Phenelzine

      Explanation:

      Toxicity in Overdose: Comparing MAOIs, SSRIs, Tricyclics, and Mirtazapine

      When it comes to the risk of overdose, not all antidepressants are created equal. MAOIs (except for moclobemide) have a high toxicity level, with as little as 400 mg of phenelzine being potentially fatal. On the other hand, SSRIs are considered relatively safe in overdose. Tricyclics, except for lofepramine, have a higher risk of toxicity in overdose. However, lofepramine is relatively safe in overdose. Mirtazapine, while sedative, has a low risk of toxicity even in large doses, and may not produce any symptoms. It’s important to note that regardless of the perceived safety of a medication, any overdose should be taken seriously and medical attention should be sought immediately.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 26 - What is a typical adverse effect associated with the use of carbamazepine? ...

    Incorrect

    • What is a typical adverse effect associated with the use of carbamazepine?

      Your Answer:

      Correct Answer: Diplopia

      Explanation:

      Diplopia is a frequently occurring side-effect, while the other options are infrequent of extremely infrequent side-effects of carbamazepine.

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

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

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

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

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

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 27 - What medication acts as both a serotonin and noradrenaline reuptake inhibitor? ...

    Incorrect

    • What medication acts as both a serotonin and noradrenaline reuptake inhibitor?

      Your Answer:

      Correct Answer: Duloxetine

      Explanation:

      SNRIs include duloxetine and venlafaxine.

      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
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  • Question 28 - What category of antipsychotic does Sulpiride belong to? ...

    Incorrect

    • What category of antipsychotic does Sulpiride belong to?

      Your Answer:

      Correct Answer: Substituted benzamide

      Explanation:

      Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 29 - What is a minimally invasive method that utilizes radioisotopes? ...

    Incorrect

    • What is a minimally invasive method that utilizes radioisotopes?

      Your Answer:

      Correct Answer: SPECT

      Explanation:

      Neuroimaging techniques can be divided into structural and functional types, although this distinction is becoming less clear as new techniques emerge. Structural techniques include computed tomography (CT) and magnetic resonance imaging (MRI), which use x-rays and magnetic fields, respectively, to produce images of the brain’s structure. Functional techniques, on the other hand, measure brain activity by detecting changes in blood flow of oxygen consumption. These include functional MRI (fMRI), emission tomography (PET and SPECT), perfusion MRI (pMRI), and magnetic resonance spectroscopy (MRS). Some techniques, such as diffusion tensor imaging (DTI), combine both structural and functional information to provide a more complete picture of the brain’s anatomy and function. DTI, for example, uses MRI to estimate the paths that water takes as it diffuses through white matter, allowing researchers to visualize white matter tracts.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 30 - What is the candidate gene for schizophrenia that is also associated with Velocardiofacial...

    Incorrect

    • What is the candidate gene for schizophrenia that is also associated with Velocardiofacial disorder?

      Your Answer:

      Correct Answer: COMT

      Explanation:

      Schizophrenia is a complex disorder that is associated with multiple candidate genes. No single gene has been identified as the sole cause of schizophrenia, and it is believed that the more genes involved, the greater the risk. Some of the important candidate genes for schizophrenia include DTNBP1, COMT, NRG1, G72, RGS4, DAOA, DISC1, and DRD2. Among these, neuregulin, dysbindin, and DISC1 are the most replicated and plausible genes, with COMT being the strongest candidate gene due to its role in dopamine metabolism. Low activity of the COMT gene has been associated with obsessive-compulsive disorder and schizophrenia. Neuregulin 1 is a growth factor that stimulates neuron development and differentiation, and increased neuregulin signaling in schizophrenia may suppress the NMDA receptor, leading to lowered glutamate levels. Dysbindin is involved in the biogenesis of lysosome-related organelles, and its expression is decreased in schizophrenia. DISC1 encodes a multifunctional protein that influences neuronal development and adult brain function, and it is disrupted in schizophrenia. It is located at the breakpoint of a balanced translocation identified in a large Scottish family with schizophrenia, schizoaffective disorder, and other major mental illnesses.

    • This question is part of the following fields:

      • Genetics
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SESSION STATS - PERFORMANCE PER SPECIALTY

Psychopharmacology (3/3) 100%
Neurosciences (2/2) 100%
Social Psychology (0/1) 0%
Advanced Psychological Processes And Treatments (1/1) 100%
Epidemiology (1/1) 100%
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