MOCK exam 2019

Question 1

Q.1 A 25 year old Asian man spend his days at home compulsively playing internet games, and risks losing his job. Select ONLY ONE checkbox per page. ☐ A. Asperger’s Syndrome ☐ B. Agoraphobia ☐ C. Depression ☐ D. Generalised Anxiety Disorder ☐ E. Internet Gaming Disorder ☐ F. Paranoid Schizophrenia ☐ G. Panic Disorder ☐ H. Schizoid Personality Disorder ☐ I. Social Anxiety ☐ J. Specific Anxiety

Answer 1

e

Question 2

Q.2 The brain region or system where Cannabinoid CB2 receptors are principally found. Select ONLY ONE checkbox per page. ☐ A. Basal ganglia ☐ B. Cerebellum ☐ C. Dorsolateral-prefrontal cortex ☐ D. Gut mucosa ☐ E. Hippocampus ☐ F. Immune system ☐ G. Reticular activating system

Answer 2

f

Question 3

Q.3 The concept or treatment with which Philippe Pinel is most closely associated. Select ONLY ONE checkbox per page. ☐ A. Description of catatonia ☐ B. Description of folie a deux ☐ C. Description of shell shock ☐ D. Electroconvulsive therapy ☐ E. Hypnosis ☐ F. Importance of heredity in mental illness ☐ G. Insulin coma therapy ☐ H. Treating patients without restraint ☐ I. Unconscious communication

Answer 3

h

Question 4

Q.4 A legal term meaning ‘intent to do harm’. Select ONLY ONE checkbox per page. ☐ A. Actus reus ☐ B. Compos mentis ☐ C. Durham rule ☐ D. Habeas corpus ☐ E. M’Naghten rule ☐ F. Mens rea ☐ G. Res judicita ☐ H. Volenti non fit injuria

Answer 4

f

Question 5

Q.5 A psychotropic agent commonly causing weight loss. Select ONLY ONE checkbox per page. ☐ A. Aripiprazole ☐ B. Buspirone ☐ C. Carbamazepine ☐ D. Lamotrigine ☐ E. Lithium ☐ F. Moclobemide ☐ G. Topiramate

Answer 5

G

Question 6

Q.6 The fourth dimension of temperament in Robert Cloninger’s model of personality, based on his Temperament and Character Inventory (the other three dimensions being: novelty seeking, harm avoidance, persistence). Select ONLY ONE checkbox per page. ☐ A. Cooperativeness ☐ B. Conscientiousness ☐ C. Introversion ☐ D. Neuroticism ☐ E. Openness to experience ☐ F. Reward dependence ☐ G. Self-directedness ☐ H. Self-transcendence

Answer 6

F

Question 7

Q.7 Immanuel Kant developed the ‘Categorical Imperative’, outlining duties towards others which govern moral actions. Select ONLY ONE checkbox per page. ☐ A. Autonomy ☐ B. Beneficence ☐ C. Consequentialism ☐ D. Deontology ☐ E. Justice ☐ F. Non-maleficence ☐ G. Teleology ☐ H. Universalism ☐ I. Utilitarianism

Answer 7

d

Question 8

Q.8 Not an aspect of behavioural epigenetics. Select ONLY ONE checkbox per page. ☐ A. A father’s increasing age causing changes in sperm with increased risk of schizophrenia in his offspring ☐ B. Addictive substances altering gene expression and increasing tendency to addiction ☐ C. DNA methylation ☐ D. DNA sequence alteration ☐ E. Environmental effects ☐ F. Epigenome modifications by childhood trauma ☐ G. Histone acetylation ☐ H. Nurture

Answer 8

d

Question 9

Q.9 Alice is a 54 year old secretary who is unhappy with her boss and wants to leave her job, but feels guilty about this. She becomes very flattering towards her boss, praising her to other staff and giving her a gift “in appreciation”. Select ONLY ONE checkbox per page. ☐ A. Denial ☐ B. Displacement ☐ C. Dissociation ☐ D. Projection ☐ E. Regression ☐ F. Repression ☐ G. Reaction formation ☐ H. Sublimation

Answer 9

g

Question 10

Q.10 The most common Personality Disorder in community adult populations in Western countries, based on a systematic review and meta-analysis. Select ONLY ONE checkbox per page. ☐ A. Antisocial Personality Disorder ☐ B. Avoidant Personality Disorder ☐ C. Borderline Personality Disorder ☐ D. Dependent Personality Disorder ☐ E. Histrionic Personality Disorder ☐ F. Narcissistic Personality Disorder ☐ G. Obsessive-Compulsive Personality Disorder ☐ H. Paranoid Personality Disorder ☐ I. Schizoid Personality Disorder ☐ J. Schizotypal Personality Disorder

Answer 10

g

Question 11

Q.11 Has borderline hypothyroidism as a risk factor. Select ONLY ONE checkbox per page. ☐ A. Binswanger disease ☐ B. Frontotemporal Dementia ☐ C. Lewy Body Dementia ☐ D. Mixed Anxiety-Depressive Disorder ☐ E. Obsessive Compulsive Disorder ☐ F. Panic Disorder ☐ G. Rapid-Cycling Bipolar Disorder ☐ H. Wernicke’s encephalopathy ☐ I. William’s Syndrome

Answer 11

g

Question 12

Q.12 Based on previous traumatic experiences, Belinda has developed a belief that it is futile to do anything to escape aversive consequences. Select ONLY ONE checkbox per page. ☐ A. Learned helplessness ☐ B. Post-Traumatic Stress Disorder ☐ C. Borderline Personality Disorder ☐ D. Aggression turned inward ☐ E. Operant conditioning ☐ F. Classical conditioning ☐ G. Object loss ☐ H. Negative attributional style

Answer 12

a

Question 13

Q.13 Not an example of Autism Spectrum Disorder. Select ONLY ONE checkbox per page. ☐ A. Angelo is very attached to his favourite childhood toy, a spaceman action figure, and dislikes change ☐ B. Asperger’s Disorder ☐ C. Autistic disorder ☐ D. Billy, a 5 year old boy, repetitively stacks cans on top of one another and avoids eye contact ☐ E. Li has difficulty interpreting social cues and body language ☐ F. Mara, a software coder, eats lunch alone at her desk and likes to watch a spinning top ☐ G. Pervasive developmental disorder not otherwise specified ☐ H. Ravi is aged 3 but has still not spoken. He often sits and rocks ☐ I. Rett’s disorder

Answer 13

i

Question 14

Q.14 A 38 year old woman frequently visits her general practitioner with multiple somatic complaints. She has done this since her twenties. Select ONLY ONE checkbox per page. ☐ A. Briquet’s Syndrome ☐ B. Capgras Syndrome ☐ C. Charles Bonnet Syndrome ☐ D. Cotard’s Syndrome ☐ E. De Clerambault’s Syndrome ☐ F. Fregoli Syndrome ☐ G. Ganser Syndrome ☐ H. Korsakoff syndrome ☐ I. Munchhausen Syndrome

Answer 14

a

Question 15

Q.15 A 21 year old woman with no history of mental illness presents with disorganised behaviour, delusions and a seizure after a week of a viral illness. CT head scan is normal. Select ONLY ONE checkbox per page. ☐ A. Copper levels ☐ B. Full blood count ☐ C. HIV serology ☐ D. Lumbar Puncture ☐ E. nMDA-r antibodies and ANA ☐ F. Renal Function tests ☐ G. Syphilis serology ☐ H. Thyroid function tests ☐ I. Urinary drug screen ☐ J. Vitamin studies

Answer 15

d

Question 16

Q.16 A 60 year old man with a diagnosis of Schizophrenia presents with poor self care, lip smacking and tongue protrusion. Select ONLY ONE checkbox per page. ☐ A. Abnormal Involuntary Movement Scale ☐ B. Beck Depression Inventory ☐ C. Brief Psychiatric Rating Scale ☐ D. Global Assessment of Function Scale ☐ E. Hamilton Scale for Depression ☐ F. Positive and Negative Syndrome Scale ☐ G. Quality of Life Scale ☐ H. Simpson-Agnus Scale

Answer 16

a

Question 17

Q.17 A 69 year old woman taking risperidone is admitted acutely with rigidity, temperature of 38 degrees and confusion. On investigation she has an elevated creatinine kinase, leucocytosis and mildly elevated liver enzymes. Select ONLY ONE checkbox per page. ☐ A. Benzodiazepine dependency ☐ B. Cigarette smoking ☐ C. Dehydration ☐ D. Family history of anxiety disorder ☐ E. Family history of depression ☐ F. Female sex ☐ G. Hyperthyroidism ☐ H. Hypothyroidism

Answer 17

c

Question 18

Q.18 Zuclopenthixol acetate should not be used in combination with which of the following antidepressants because of the potential for an interaction through shared hepatic metabolism. Select ONLY ONE checkbox per page. ☐ A. Citalopram ☐ B. Imipramine ☐ C. Mirtazapine ☐ D. Paroxetine ☐ E. Sertraline ☐ F. Tranylcypromine ☐ G. Venlafaxine

Answer 18

d

Question 19

Q.19 Not an appropriate action in the pre-psychotic phase for a patient presenting for the first time. Select ONLY ONE checkbox per page. ☐ A. Consideration of a psychotic disorder ☐ B. Employment Support ☐ C. Family Education ☐ D. Interpersonal management ☐ E. Management of co-morbid depression ☐ F. Management of problematic substance use ☐ G. Prescription of antipsychotic medication ☐ H. Psychoeducation ☐ I. Regular family contact ☐ J. Regular monitoring of mental state

Answer 19

g

Question 20

Q.20 A 79 year old woman living on a farm is brought in by her daughter with a history of confused episodes. She has tremor and festination, and is annoyed by “tiny nuns” who she says sit in the pine trees outside her window. Select ONLY ONE checkbox per page. ☐ A. Alzheimer’s disease ☐ B. Chronic subdural haematoma ☐ C. Left frontal meningioma ☐ D. Lewy-body dementia ☐ E. Multi-infarct dementia ☐ F. Multiple sclerosis ☐ G. Normal pressure hydrocephalus ☐ H. Pick’s disease ☐ I. Right middle cerebral infarct ☐ J. Subarachnoid haemorrhage

Answer 20

d

Question 21

Q.21 A 43 year old male immigrant’s family tell his doctor that he is suffering from Khyal Cap (wind attacks). Select ONLY ONE checkbox per page. ☐ A. Botswana ☐ B. Cambodia ☐ C. Cuba ☐ D. Indonesia ☐ E. Nigeria ☐ F. Papua New Guinea ☐ G. Sudan ☐ H. Taiwan ☐ I. Yemen ☐ J. Zimbabwe

Answer 21

b

Question 22

Q.22 An example of a Schneiderian first rank symptom. Select ONLY ONE checkbox per page. ☐ A. Abulia ☐ B. Affective flattening ☐ C. Auditory Hallucinations experienced as a running commentary ☐ D. Auditory hallucinations experienced as two or more voices talking amongst themselves ☐ E. Delusions of misidentification ☐ F. Delusions of reference ☐ G. Ego boundary blurring ☐ H. Persecutory delusions ☐ I. Secondary delusions ☐ J. Thought diffusion

Answer 22

c

Question 23

Q.23 The percentage of the population who will meet the diagnostic criteria for schizophrenia over their lifetime. Select ONLY ONE checkbox per page. ☐ A. 0.01 ☐ B. 0.1 ☐ C. 0.2 ☐ D. 0.5 ☐ E. 1.0 ☐ F. 2 ☐ G. 2.5 ☐ H. 3 ☐ I. 5 ☐ J. 10

Answer 23

e

Question 24

Q.24 A function regulated by 5HT3 receptors. Select ONLY ONE checkbox per page. ☐ A. Anxiety ☐ B. Circadian rhythms ☐ C. Cognition ☐ D. Mood ☐ E. Nausea ☐ F. Stress response ☐ G. Thermoregulation

Answer 24

e

Question 25

Q.25 Medication to co-administer when starting someone on clozapine. Select ONLY ONE checkbox per page. ☐ A. Docusate Sodium ☐ B. Docusate sodium and Sennoside B ☐ C. Fleet Enema ☐ D. Lactulose ☐ E. Lax-sachets ☐ F. Magnesium hydroxide ☐ G. Microlax enema ☐ H. Movicol ☐ I. Psyllium husk powder

Answer 25

b

Question 26

Q.26 Aroha, a 27 year old woman with a history of schizophrenia, says that the pins and needles she experiences are due to ‘space rays’ being fired at her. Select ONLY ONE checkbox per page. ☐ A. Bizarre Delusion ☐ B. Delusion of Control ☐ C. Delusion of Reference ☐ D. Mood-congruent Delusion ☐ E. Nihilistic Delusion ☐ F. Paranoid Delusion ☐ G. Passivity Delusion ☐ H. Somatic Delusion

Answer 26

h

Question 27

Q.27 A psychiatrist in a movie has a sexual encounter with the brother of the patient she is treating with psychodynamic psychotherapy, while meeting with him to obtain collateral information. Select ONLY ONE checkbox per page. ☐ A. Boundary violation ☐ B. Displacement ☐ C. Empathic failure ☐ D. Mirroring ☐ E. Objectification ☐ F. Parallel process ☐ G. Positive transference ☐ H. Projective identification

Answer 27

a

Question 28

Q.28 Vicky, a 20 year old woman, has been in the acute inpatient ward for 3 weeks with first episode psychosis. She is being treated with Risperidone – 1 mg initially, then 2mg for the past 17 days. She remains psychotic. Select ONLY ONE checkbox per page. ☐ A. Add Lithium ☐ B. Add regular benzodiazepine ☐ C. Add a selective serotonin reuptake inhibitor ☐ D. Augment with Aripiprazole ☐ E. Change to Olanzapine ☐ F. Increase dose of Risperidone to 4 mg ☐ G. Increase dose of Risperidone to 6mg

Answer 28

f

Question 29

Q.29 Sarah, aged 7, presents with her foster parents of three years. They say their key difficulty with Sarah is demanding behaviour in the supermarket and similar settings. They report that they ignore her pleas for sweets for up to 15 minutes, but eventually they have to give her a chocolate bar to avoid a half hour tantrum at the supermarket checkout. Select ONLY ONE checkbox per page. ☐ A. Behavioural Contingencies ☐ B. Eriksonian Stage – Autonomy vs Shame/Doubt ☐ C. Eriksonian Stage – Identity vs Role Confusion ☐ D. Insecure attachment – avoidant type ☐ E. Insecure attachment – disorganised insecure type ☐ F. Learned helplessness ☐ G. Patterson’s cycle of coercion

Answer 29

g

Question 30

Q.30 A 63 year old woman has suspected neurotoxicity from lithium treatment, despite her serum lithium levels being in the quoted normal range. Select ONLY ONE checkbox per page. ☐ A. ECG ☐ B. EEG ☐ C. MoCA ☐ D. MRI scan ☐ E. PET scan ☐ F. SPECT scan ☐ G. Serum potassium ☐ H. Serum TSH

Answer 30

b

Question 31

Q.31 A 50 year old man presents with concerns that his wife has been unfaithful. He has a two year history of these beliefs but is otherwise functioning well. No collateral evidence supports his concerns. Select ONLY ONE checkbox per page. ☐ A. Brief Psychotic Disorder ☐ B. Delusional Disorder ☐ C. Jealousy ☐ D. Major Depressive Disorder ☐ E. Obsessive Compulsive Disorder ☐ F. Paranoid Personality disorder ☐ G. Relationship Difficulties ☐ H. Schizoaffective Disorder ☐ I. Schizophrenia ☐ J. Schizophreniform Disorder ☐ K. Schizotypal Personality Disorder

Answer 31

b

Question 32

Q.32 Very preterm birth (less than 32 weeks gestation). Select ONLY ONE checkbox per page. ☐ A. Cerebral palsy in more than 30% of survivors ☐ B. Higher incidence of reactive attachment disorder ☐ C. Inattention, anxiety, and socio-emotional difficulties in childhood ☐ D. Lower rates of eating disorders in adulthood ☐ E. Minimal effect upon thalamocortical and corticostriatial connectivity ☐ F. Significantly increased rates of conduct disorder in late adolescence ☐ G. Similar rates in adulthood of bipolar affective disorder to term controls

Answer 32

c

Question 33

Q.33 A 35 year old office worker goes tramping and on the second day, suffers from moderate headaches and sleepiness. Select ONLY ONE checkbox per page. ☐ A. Alcohol Withdrawal ☐ B. Caffeine Withdrawal ☐ C. Cluster Headache ☐ D. Depression ☐ E. Meningitis ☐ F. Migraine ☐ G. Sensory Overload ☐ H. Chronic Fatigue ☐ I. Tension Headache

Answer 33

b

Question 34

Q.34 A substrate metabolized by MAO-B but not MAO-A. Select ONLY ONE checkbox per page. ☐ A. Acetylcholine ☐ B. Dopamine ☐ C. Histamine ☐ D. Noradrenaline ☐ E. Phenylethylamine ☐ F. Serotonin ☐ G. Tyramine

Answer 34

e

Question 35

Q.35 Not associated with Ganser syndrome. Select ONLY ONE checkbox per page. ☐ A. Balderdash syndrome ☐ B. Conversion disorder ☐ C. Decreased state of consciousness ☐ D. Dissociative amnesia ☐ E. Dissociative disorder ☐ F. Fugue state ☐ G. Gedankenlautverden ☐ H. Hysterical pseudodementia ☐ I. Prison psychosis ☐ J. Syndrome of approximate answers ☐ K. Visual pseudohallucinations ☐ L. Vorbeireden

Answer 35

g

Question 36

Q.36 David is a 12 year old boy, referred due to behavioural problems and poor learning in the classroom. The team psychologist has completed a WISC which shows a Full Scale IQ of 68. Select ONLY ONE checkbox per page. ☐ A. Adaptive Behaviour Assessment Scale (ABAS) ☐ B. Autism Diagnostic Observation Scale (ADOS) ☐ C. Child Behaviour Checklist (CBCL/Rutter) ☐ D. Conners Comprehensive Behaviour Rating Scale (Conners CBRS) ☐ E. Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) ☐ F. Millon Adolescent Personality Inventory (MAPI) ☐ G. Weschler Intelligence Scale (WAIS)

Answer 36

a

Question 37

Q.37 A tic. Select ONLY ONE checkbox per page. ☐ A. A peculiar and characteristic individual style of movement ☐ B. An involuntary, sudden, rapid, recurrent, non-rhythmic motor movement or vocalisation ☐ C. An urge to move the legs, accompanied by unpleasant sensations, relieved by movement ☐ D. Disordered muscle tone ☐ E. Distortion of voluntary movements with involuntary muscle activity ☐ F. Excessive motor activity associated with a feeling of inner tension ☐ G. Odd and inappropriate facial expressions unrelated to the situation ☐ H. Persistent eating of non-nutritive non-food substances

Answer 37

b

Question 38

Q.38 Diagnostic and Classificatory systems. Select ONLY ONE checkbox per page. ☐ A. Adam Guillaume and his grandson Jean Bertrand were the founders of the ICD system ☐ B. Current classification systems in psychiatry are aetiologically based, rather than descriptive ☐ C. DSM-III was published in 1985 ☐ D. Greater focus on validity rather than reliability tends to create increasing numbers of diagnostic categories ☐ E. ICD-11 will be focussed on clincial utility ☐ F. Operational diagnostic criteria were first introduced to the DSM system with DSM-IV ☐ G. Research Domain Criteria (RDoC), linked to neurobiological correlates, pre-dated the DSM system ☐ H. The ‘Zone of rarity’ is more often present in psychiatric disorders than in the rest of medicine

Answer 38

e

Question 39

Q.39 The rate of misdiagnosis of conversion disorder due to missing an occult, causative pathology. Select ONLY ONE checkbox per page. ☐ A. Decreased in more recent years due to the widespread availability of advanced neuroimaging such as MRI scans ☐ B. Has been very low (less than 5%) since the 1970s ☐ C. Increased in more recent years due to the diagnosis of conversion disorder being made more often in primary care settings ☐ D. Stayed around 60%, i.e. the diagnosis of conversion disorder is more often wrong than right ☐ E. Stayed the same since DSM-III in 1980 as there have been no changes in the classification of conversion disorders since then

Answer 39

b

Question 40

Q.40 The third dimension according to which Emil Kraepelin classified mixed mood states – the other two being mood and motor activity. Select ONLY ONE checkbox per page. ☐ A. Anxiety ☐ B. Distractibility ☐ C. Hazardous behaviour ☐ D. Irritability ☐ E. Libido ☐ F. Self esteem ☐ G. Sleep ☐ H. Speed of thought

Answer 40

h

Question 41

Q.41 Sam, a young man aged 18, first presented four months ago with paranoid delusions and auditory hallucinations. Despite trials with three antipsychotics, his auditory hallucinations remain. Select ONLY ONE checkbox per page. ☐ A. Stage 0 ☐ B. Stage 1a ☐ C. Stage 1b ☐ D. Stage 2 ☐ E. Stage 3a ☐ F. Stage 3b ☐ G. Stage 3c ☐ H. Stage 4

Answer 41

e

Question 42

Q.42 Henry, aged 79, develops muscle twitching while still unconscious after his ECT treatment – reapplication of the EEG shows this to be a tardive seizure. Select ONLY ONE checkbox per page. ☐ A. Carbamazepine orally ☐ B. Diazepam intramuscularly ☐ C. Diazepam intravenously ☐ D. Midazolam intravenously ☐ E. Mirtazapine orally ☐ F. Olanzapine oral wafer ☐ G. Olanzapine short-acting injection ☐ H. Re-treat with ECT immediately ☐ I. Sodium valproate orally ☐ J. Terminate ECT course

Answer 42

d

Question 43

Q.43 Developed Interpersonal and Social Rhythm Therapy. Select ONLY ONE checkbox per page. ☐ A. Adrian Wells ☐ B. Anthony Bateman ☐ C. Ellen Frank ☐ D. Gerald Klerman ☐ E. John Teasdale ☐ F. Marsha Linehan ☐ G. Myrna Weissman ☐ H. Steven Hayes

Answer 43

c

Question 44

Q.44 The smell of fresh muffins in a bakery makes a man’s mouth water as he waits to be served. Select ONLY ONE checkbox per page. ☐ A. Classical conditioning ☐ B. Counter-conditioning ☐ C. Episodic memory ☐ D. Operant conditioning ☐ E. Semantic memory ☐ F. Sensory memory ☐ G. Shaping ☐ H. Short-term memory

Answer 44

a

Question 45

Q.45 Emily is 17 and has been wheelchair-bound and off school since breaking her ankle in a netball game 13 months ago. Her surgeon has said that the bones have healed normally, however she has been experiencing increasingly severe pain in her ankle, and is unable to weight-bear. Her ankle is cooler than the other side, and the skin looks blotchy. She insists she is not depressed. Select ONLY ONE checkbox per page. ☐ A. She has chronic regional pain syndrome, which has developed due to underlying unrecognised depression and alexithymia ☐ B. She has a factitious disorder, as the fracture has fully healed ☐ C. Her pain is probably due to ongoing primary nociceptive input, despite the normal scans, and her ankle should be immobilised in a splint ☐ D. She has chronic regional pain syndrome, which is untreatable and she should complete her education by correspondence ☐ E. She has chronic regional pain syndrome, and part of her treatment plan should include exploring reasons for why she has been unable to transition back to school ☐ F. The skin appearance changes indicate that there are nutritional deficits that should be corrected ☐ G. She should be started on Venlafaxine as this has evidence for efficacy in chronic pain in adolescents

Answer 45

e

Question 46

Q.46 The majority of noradrenergic neurons in the brain arise from this anatomic structure. Select ONLY ONE checkbox per page. ☐ A. Dorsal raphe nucleus ☐ B. Dorsal stratum ☐ C. Hippocampus ☐ D. Locus coeruleus ☐ E. Median raphe nucleus ☐ F. Nucleus basalis of Meynert ☐ G. Ventral tegmental area

Answer 46

d

Question 47

Q.47 A feature that does not support the specifier “with good prognostic features” in a patient with Schizophreniform Disorder. Select ONLY ONE checkbox per page. ☐ A. Blunted affect ☐ B. Good premorbid occupational functioning ☐ C. Good premorbid social functioning ☐ D. Normal cognitive functioning ☐ E. Onset of symptoms within four weeks of first change in functioning or behavior ☐ F. Symptoms are accompanied by confusion ☐ G. Symptoms are accompanied by perplexity

Answer 47

a

Question 48

Q.48 Collectivist cultures. Select ONLY ONE checkbox per page. ☐ A. Are known for interconnectedness with others playing a central role in each person’s identity ☐ B. Are more complex to consider using Beauchamp and Childress’s principles ☐ C. Are more likely to explain something via external causality than self-direction ☐ D. Are less context dependent in their perceptions ☐ E. Emphasize the family above individual needs or desires ☐ F. Tend to accept that different groups have different values ☐ G. Value decisions made by the family or family elders over individual autonomy ☐ H. Value work group or family goals above individual achievements

Answer 48

d

Question 49

Q.49 Ralph is a 15 year old boy who has recently told his parents that he’s bisexual. His family have told him he’s confused due to his mother being overwhelmed in his early life by the arrival of a baby sister when he was only 11 months old. Select ONLY ONE checkbox per page. ☐ A. Eriksonian Stage – Autonomy vs Shame/Doubt ☐ B. Eriksonian Stage – Ego Integrity vs. Despair ☐ C. Eriksonian Stage – Generativity vs. Stagnation ☐ D. Eriksonian Stage – Identity vs Role Confusion ☐ E. Eriksonian Stage – Industry vs Inferiority ☐ F. Eriksonian Stage – Initiative vs Guilt ☐ G. Eriksonian Stage – Intimacy vs Isolation ☐ H. Eriksonian Stage – Trust vs Mistrust

Answer 49

d

Question 50

Q.50 Monitoring symptoms in a patient with schizophrenia. Select ONLY ONE checkbox per page. ☐ A. AIMS ☐ B. BPRS ☐ C. GAF ☐ D. HAMD ☐ E. MADRS ☐ F. PANSS ☐ G. SANS ☐ H. SAPS ☐ I. SCID

Answer 50

b

Question 51

Q.51 Lack of insight in severe, chronic schizophrenia. Select ONLY ONE checkbox per page. ☐ A. Anosognosia ☐ B. Astereognosis ☐ C. Autotopagnosia ☐ D. Cerebral achromatopsia ☐ E. Environmental agnosia ☐ F. Phonagnosia ☐ G. Prosopagnosia ☐ H. Simultagnosia

Answer 51

a

Question 52

Q.52 Psychoeducation of patients. Select ONLY ONE checkbox per page. ☐ A. A Kantian categorical imperative ☐ B. Autonomy ☐ C. Beneficence ☐ D. Ethical relativism ☐ E. Justice ☐ F. Non-maleficence ☐ G. Practical wisdom ☐ H. Utilitarianism

Answer 52

b

Question 53

Q.53 “Then I left Timaru and moved to… where did you get that tie?” Select ONLY ONE checkbox per page. ☐ A. Clanging ☐ B. Command hallucinations ☐ C. Delusions of control ☐ D. Distractibility ☐ E. Echolalia ☐ F. Knight’s move thinking ☐ G. Perseveration ☐ H. Tangentiality ☐ I. Thought Blocking

Answer 53

d

Question 54

Q.54 Not part of a routine physical assessment in a patient presenting with first episode psychosis. Select ONLY ONE checkbox per page. ☐ A. Anti-NMDAR antibodies ☐ B. Electrocardiogram ☐ C. Electroencephalography ☐ D. Electrolytes ☐ E. Fasting Glucose ☐ F. Full blood count ☐ G. Hepatitis Screen ☐ H. Lipids ☐ I. Neurological Examination ☐ J. Thyroid Function Tests ☐ K. Urinary Drug Screen

Answer 54

e

Question 55

Q.55 Used to treat obsessive-compulsive disorder. Select ONLY ONE checkbox per page. ☐ A. Brief psychodynamic therapy ☐ B. CBT-oriented group therapy ☐ C. Exposure and response prevention ☐ D. Expressive therapy ☐ E. Family therapy ☐ F. Interpersonal therapy ☐ G. Marital therapy ☐ H. Mindfulness training ☐ I. Motivational interviewing ☐ J. Systematic desensitisation

Answer 55

c

Question 56

Q.56 Bianca is a 6 year old girl who often has temper tantrums. She once set her doll’s house on fire while playing and when taken to task afterwards, blamed her brother for it. She is liked by her peers, but known as a “troublemaker” by her teachers and argues a lot with her parents. She loves her cat and looks after him well. Select ONLY ONE checkbox per page. ☐ A. Adjustment disorder with mixed disturbance of emotions and conduct ☐ B. Autistic spectrum disorder ☐ C. Conduct disorder ☐ D. Disruptive mood dysregulation disorder ☐ E. Intermittent explosive disorder ☐ F. Oppositional defiant disorder ☐ G. Psychopathy ☐ H. Social anxiety disorder

Answer 56

f

Question 57

Q.57 A 52 year old man presents with a longstanding court battle against a former employee which he says is an “attack on my character”. He says the court battle has lost him friends as they didn’t side with him and betrayed him. He says this only goes to show that he’s always been right to mistrust others. Select ONLY ONE checkbox per page. ☐ A. Brief Psychotic Disorder ☐ B. Delusional Disorder ☐ C. Major Depressive Disorder ☐ D. Narcissistic Personality disorder ☐ E. Obsessive Compulsive Disorder ☐ F. Paranoid Personality disorder ☐ G. Schizoaffective Disorder ☐ H. Schizoid Personality Disorder ☐ I. Paranoid schizophrenia ☐ J. Schizotypal Personality Disorder

Answer 57

f

Question 58

Q.58 “Is your name Margery?” “Yes.” “Are you in hospital?” “Yes.” “Are you a table?” “Yes.” Select ONLY ONE checkbox per page. ☐ A. Clanging ☐ B. Distractability ☐ C. Echolalia ☐ D. Incoherence ☐ E. Knight’s move thinking ☐ F. Loss of goal ☐ G. Perseveration ☐ H. Tangentiality

Answer 58

g

Question 59

Q.59 Synthesized from the amino acid tyrosine. Select ONLY ONE checkbox per page. ☐ A. Acetylcholine ☐ B. Dopamine ☐ C. Gamma-aminobutyric acid ☐ D. Glutamate ☐ E. Glycine ☐ F. Noradrenaline ☐ G. Serotonin

Answer 59

b

Question 60

Q.60 Developed an 11-item rating scale for mania. Select ONLY ONE checkbox per page. ☐ A. Barnes ☐ B. Beck ☐ C. Brown ☐ D. Hamilton ☐ E. Hare ☐ F. Montgomery and Asberg ☐ G. Young ☐ H. Zung

Answer 60

g

Question 61

Q.61 A man with a long history of theft is arrested for stealing cars after police find his fingerprints on a stolen BMW. Select ONLY ONE checkbox per page. ☐ A. Actus reus ☐ B. Disease of the mind ☐ C. Fitness to plead ☐ D. Forseeability ☐ E. Irresistible impulse ☐ F. Mens rea ☐ G. Natural Justice ☐ H. Provocation ☐ I. Sane Automatism

Answer 61

a

Question 62

Q.62 A 25 year old man lives alone and reports being very lonely. He says he feels inadequate and needs reassurance before attempting any activity or interpersonal interaction, for fear of humiliation. Select ONLY ONE checkbox per page. ☐ A. Antisocial Personality Disorder ☐ B. Avoidant Personality Disorder ☐ C. Borderline Personality Disorder ☐ D. Dependent Personality Disorder ☐ E. Histrionic Personality Disorder ☐ F. Narcissistic Personality Disorder ☐ G. Paranoid Personality Disorder ☐ H. Passive-Aggressive Personality Disorder ☐ I. Schizoid Personality Disorder ☐ J. Schizotypal Personality Disorder

Answer 62

b

Question 63

Q.63 The brain region synchronizing the synthesis of melatonin to the light/dark cycle. Select ONLY ONE checkbox per page. ☐ A. Dorsomedial nucleus ☐ B. Medial septal nucleus ☐ C. Nucleus accumbens ☐ D. Paraventricular nucleus ☐ E. Posterior nucleus ☐ F. Red nucleus ☐ G. Suprachiasmatic nucleus ☐ H. Ventromedial nucleus

Answer 63

g

Question 64

Q.64 A tall young man has a rounded body-type and is teased at school for his gynaecomastia. Investigation reveals an XXY chromosomal pattern. Select ONLY ONE checkbox per page. ☐ A. Adrenogenital syndrome ☐ B. Gender identity disorder ☐ C. Klinefelter’s syndrome ☐ D. Polycystic ovarian syndrome ☐ E. Pseudohermaphroditism ☐ F. Transvestic Fetishism ☐ G. Turner’s syndrome ☐ H. Testicular feminisation syndrome

Answer 64

c

Question 65

Q.65 “Bulldogs are from England. They have good fish and chips there. Fish breathe underwater.” Select ONLY ONE checkbox per page. ☐ A. Bizarre Delusions ☐ B. Circumstantiality ☐ C. Clanging ☐ D. Derailment ☐ E. Distractability ☐ F. Knight’s move thinking ☐ G. Paraphasias ☐ H. Perseveration ☐ I. Tangential thinking ☐ J. Thought Insertion

Answer 65

i

Question 66

Q.66 Gabriella, who is being treated for psychosis, develops a headache, nausea and vomiting. Her urine sodium concentration is greater than 20 mEq/L. Select ONLY ONE checkbox per page. ☐ A. Cushings disease ☐ B. Graves disease ☐ C. Phaeochromocytoma ☐ D. Porphyria ☐ E. Psychogenic polydipsia ☐ F. Renal failure ☐ G. SIADH ☐ H. Wilson’s disease

Answer 66

g

Question 67

Q.67 Darius, aged 22, presents with a two year history of functional decline with poor motivation. His family say that for the last month they have had difficulty following what he’s saying and that he has been concerned about aliens harming him. They report a similar episode 18 months ago which was short-lived – they didn’t take him to see his GP then as he improved. Select ONLY ONE checkbox per page. ☐ A. Schizophrenia, continuous ☐ B. Schizophrenia, first episode, currently in acute episode ☐ C. Schizophrenia, first episode, in partial remission ☐ D. Schizophrenia, first episode, in full remission ☐ E. Schizophrenia, multiple episodes, currently in acute episode ☐ F. Schizophrenia, multiple episodes, currently in partial remission ☐ G. Schizophrenia, multiple episodes, currently in full remission ☐ H. Schizophreniform Disorder, with good prognostic features ☐ I. Schizophreniform Disorder, without good prognostic features

Answer 67

b

Question 68

Q.68 The first comprehensive, multi-informant epidemiological study of childhood psychopathology. Select ONLY ONE checkbox per page. ☐ A. The Achenbach System of Empirically Based Assessment Study ☐ B. The Avon Longitudinal Study of Parents and Children ☐ C. The CATIE study ☐ D. The Christchurch Health and Development Study ☐ E. The Dunedin Multidisciplinary Health and Development Study ☐ F. The Great Smokey Mountain Study ☐ G. The Isle of Wight Study ☐ H. The Ontario Child Health Study

Answer 68

g

Question 69

Q.69 A client-centered, semi-directive method of engaging intrinsic motivation to change behavior by developing discrepancy and exploring and resolving ambivalence within the client. Select ONLY ONE checkbox per page. ☐ A. 12-step programme ☐ B. Adherence therapy ☐ C. Cognitive behavioural therapy ☐ D. Harm minimisation ☐ E. Motivational interviewing ☐ F. Prochaska & DiClemente’s Wheel of Change ☐ G. Psychoeducation ☐ H. Systematic desensitisation

Answer 69

e

Question 70

Q.70 Tanvir, a 24 year old Bangladeshi man, has been in hospital for eight weeks with his second psychotic episode. There has been minimal improvement despite treatment with Risperidone. The dose was titrated up since admission and has been 6mg for the past 4 weeks. Select ONLY ONE checkbox per page. ☐ A. Augment with Lorazepam ☐ B. Augment with Ziprasidone ☐ C. Change to Aripiprazole ☐ D. Change to Clozapine ☐ E. Change to Olanzapine ☐ F. Electroconvulsive therapy ☐ G. Increase Risperidone to 8mg ☐ H. Wait a further two weeks

Answer 70

c

Question 71

Q.71 Atypical depression is thought to be most closely related to which disorder listed below? Select ONLY ONE checkbox per page. ☐ A. Alcoholism ☐ B. Bipolar disorder ☐ C. Borderline personality disorder ☐ D. Bulimia nervosa ☐ E. Catatonia ☐ F. Panic disorder ☐ G. Schizophrenia

Answer 71

b

Question 72

Q.72 Features of holistic Mäori concepts of health (including Te Whare Tapa Wha, Te Wheke and Nga Pou Mana). Select ONLY ONE checkbox per page. ☐ A. Cultural heritage (Taonga tuku iho) ☐ B. Emotions (Whatumanawa) ☐ C. Environment (Te ao turoa) ☐ D. Family (Whänau) ☐ E. Land base (Turangawaewae) ☐ F. Mental health (Hinengaro) ☐ G. Physical health (Tinana) ☐ H. Self determination (Tino rangatiratanga) ☐ I. Spirituality (Wairua) ☐ J. Uniqueness (Mana ake) ☐ K. Vitality (Mauri)

Answer 72

h

Question 73

Q.73 The bon-bon sign. Select ONLY ONE checkbox per page. ☐ A. Acute Dystonia ☐ B. Akathisia ☒ C. Chronic Dystonia ☐ D. Oculogyric Crisis ☐ E. Medication Induced Tremor ☐ F. Neuroleptic Malignant Syndrome ☐ G. Pseudo-parkinsonism ☐ H. Tardive Dyskinesia

Answer 73

h

Question 74

Q.74 A sales clerk loses his ability to make change and write clearly, and cannot say whether you are holding up your thumb or index finger. Select ONLY ONE checkbox per page. ☐ A. Anosognosia ☐ B. Autotopagnosia ☐ C. Dysaesthesia ☐ D. Dyscalculia ☐ E. Dysgeusia ☐ F. Palinopsia ☐ G. Pareidolia ☐ H. Prosopagnosia ☐ I. Simultanagnosia ☐ J. Visual agnosia

Answer 74

d

Question 75

Q.75 Role dispute or Role transition are two of the four areas of focus. Select ONLY ONE checkbox per page. ☐ A. Brief psychodynamic therapy ☐ B. CBT-oriented group therapy ☐ C. Exposure and response prevention ☐ D. Expressive therapy ☐ E. Family therapy ☐ F. Interpersonal therapy ☐ G. Marital therapy ☐ H. Mindfulness training ☐ I. Motivational interviewing ☐ J. Systematic desensitisation

Answer 75

f

Question 76

Q.76 Negative cognitions about oneself, the world and the future. Select ONLY ONE checkbox per page. ☐ A. All-or-nothing thinking ☐ B. Automatic thoughts ☐ C. Catastrophising ☐ D. Disqualifying the positive ☐ E. Emotional reasoning ☐ F. ‘Fortune teller’ cognitive distortions ☐ G. Mislabelling ☐ H. Overgeneralization ☐ I. Personalization ☐ J. The cognitive triad

Answer 76

j

Question 77

Q.78 The most appropriate antipsychotic to use in a patient with a prolonged QTc interval. Select ONLY ONE checkbox per page. ☐ A. Amisulpride ☐ B. Aripiprazole ☐ C. Chlorpromazine ☐ D. Clozapine ☐ E. Haloperidol ☐ F. Olanzapine ☐ G. Quetiapine ☐ H. Ziprasidone

Answer 77

b/f

Question 78

Q.79 Barbara is a 63 year old woman who presents with dysphoric mood, irritability, panic attacks, pressured speech, agitation and suicidal ideation. Select ONLY ONE checkbox per page. ☐ A. Bupropion ☐ B. Carbamazepine ☐ C. Citalopram ☐ D. Lithium ☐ E. Nortriptyline ☐ F. Sodium valproate ☐ G. Topiramate ☐ H. Tranylcypromine

Answer 78

f

Question 79

Q.80 Tom is a 25 year old man who was admitted with first episode psychosis. His symptoms have completely resolved on Amisulpride. Tom would like to know how long to continue taking Amisulpride. Select ONLY ONE checkbox per page. ☐ A. Five years from the resolution of his symptoms ☐ B. Six months from the resolution of his symptoms ☐ C. Three months from the resolution of his symptoms ☐ D. Tom should never stop the Amisulpride ☐ E. Tom should only stop the Amisulpride if he’s experiencing side effects ☐ F. Twelve months from the resolution of his symptoms ☐ G. Two years months from the resolution of his symptoms

Answer 79

f

Question 80

Q.77 Linked with velocardiofacial syndrome and schizophrenia. Select ONLY ONE checkbox per page. ☐ A. CAG trinucleotide repeats ☐ B. Chromosome 21 linkages ☐ C. Chromosome 22q deletions ☐ D. Genetic polymorphism of acetaldehyde dehydrogenase ☐ E. Intermediate P450 2D6 metabolizer phenotypes ☐ F. P450 1A2 polymorphisms ☐ G. P450 3A4 polymorphisms ☐ H. Ultra-rapid P450 2D6 metabolizer phenotypes

Answer 80

c

Question 81

Q.81 Brian, aged 68, develops memory deficits and is arrested after urinating in public at a local park. Select ONLY ONE checkbox per page. ☐ A. Acting out ☐ B. Alzheimer’s dementia ☐ C. Delirium ☐ D. Exhibitionism ☐ E. Frontal tumour ☐ F. Hypomania ☐ G. Late onset schizophrenia ☐ H. Parkinson’s disease

Answer 81

b

Question 82

Q.82 A man in a neurological ward can copy a picture of a clockface but cannot say what the picture represents. Select ONLY ONE checkbox per page. ☐ A. Astereognosis ☐ B. Autotopagnosia ☐ C. Dysgeusia ☐ D. Fausse reconnaissance ☐ E. Jamais vu ☐ F. Prosopagnosia ☐ G. Visual agnosia ☐ H. Visual illusion

Answer 82

g

Question 83

Q.83 Alice, a 45 year old woman in supported accommodation who has chronic schizophrenia, is noted to be drinking water excessively. Her serum sodium concentration is low. Select ONLY ONE checkbox per page. ☐ A. Cushings disease ☐ B. Graves disease ☐ C. Hypothyroidism ☐ D. Liver failure ☐ E. Phaeochromocytoma ☐ F. Porphyria ☐ G. Psychogenic polydipsia ☐ H. Renal failure ☐ I. SIADH ☐ J. Wilson’s disease

Answer 83

g

Question 84

Q.84 Angela is a 12 year old girl who has been referred due to her teachers’ concern about her marked inattention in class – she often gets up before completing her work to stare out the window. Select ONLY ONE checkbox per page. ☐ A. Adaptive Behaviour Assessment Scale (ABAS) ☐ B. Autism Diagnostic Observation Scale (ADOS) ☐ C. Child Behaviour Checklist (CBCL/Rutter) ☐ D. Conners Comprehensive Behaviour Rating Scale (Conners CBRS) ☐ E. Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) ☐ F. Millon Adolescent Personality Inventory (MAPI) ☐ G. Weschler Intelligence Scale for Children (WISC)

Answer 84

d

Question 85

Q.85 A 19 year young old man with psychosis who was started on Risperidone two days ago presents with his eyes rolled back in his head. He is in acute distress and discomfort. Select ONLY ONE checkbox per page. ☐ A. Benztropine 2mg intramuscularly ☐ B. Benzotropine 2mg intravenously across several minutes. ☐ C. Benztropine 2mg orally ☐ D. Diazepam 5mg intramuscularly ☐ E. Lorazepam 2mg intramuscularly ☐ F. Lorazepam 2mg intravenously across several minutes. ☐ G. Lorazepam 2mg orally ☐ H. Propranolol 10mg orally

Answer 85

b

Question 86

Q.86 Molly, aged 50, has a longstanding bipolar disorder treated with lithium carbonate. She develops difficulty swallowing. Select ONLY ONE checkbox per page. ☐ A. AIMS assessment ☐ B. Barium swallow ☐ C. Chest X-Ray ☐ D. CT head and neck ☐ E. EEG ☐ F. Gastroscopy ☐ G. Lateral neck X-Ray ☐ H. MRI scan ☐ I. Serum calcium

Answer 86

g

Question 87

Q.87 Neurotransmitter that stimulates release of prolactin from the pituitary. Select ONLY ONE checkbox per page. ☐ A. Acetylcholine ☐ B. Dopamine ☐ C. GABA ☐ D. Glutamate ☐ E. Glycine ☐ F. Histamine ☐ G. Noradrenaline ☐ H. Serotonin

Answer 87

h

Question 88

Q.88 “Grass is green, violets are, um, blue. I was a fish, but then it didn’t snow.” Select ONLY ONE checkbox per page. ☐ A. Clanging ☐ B. Derailment ☐ C. Echolalia ☐ D. Palilalia ☐ E. Paraphasia ☐ F. Perseveration ☐ G. Tangentiality ☐ H. Thought blocking

Answer 88

b

Question 89

Q.89 A feature that does not suggest an underlying bipolar disorder in a patient presenting with depression. Select ONLY ONE checkbox per page. ☐ A. Late age of onset ☐ B. More than four previous episodes of depression ☐ C. Marked psychomotor slowing ☐ D. Postpartum onset ☐ E. Previous depressive episodes of short duration and rapid onset and offset ☐ F. Repeated loss of efficacy of antidepressants after an initial response ☐ G. Seasonal pattern to symptoms

Answer 89

a

Question 90

Q.90 Gina, aged 25, develops chest pain and dizziness five weeks after commencing clozapine. Select ONLY ONE checkbox per page. ☐ A. Agranulocytosis ☐ B. Dehydration ☐ C. Hypernatremia ☐ D. Mitral valve prolapse ☐ E. Myocardial infarction ☐ F. Myocarditis ☐ G. Panic attack ☐ H. Pericardial effusion ☐ I. Somatisation ☐ J. Torsades des pointes

Answer 90

f

Question 91

Q.91 A 22 year old woman with bipolar disordered treated with olanzapine monotherapy presents with minimal verbal response, no response to instructions, and no visible movements. All physical investigations are normal. Select ONLY ONE checkbox per page. ☐ A. Add Lithium ☐ B. Add Sodium Valproate ☐ C. Change antipsychotic ☐ D. Continue Olanzapine and start Lorazepam ☐ E. Continue Olanzapine and start Fluoxetine ☐ F. Continue Olanzapine and start Venlafaxine ☐ G. Electroconvulsive therapy ☐ H. Increase Olanzapine dose ☐ I. Stop Olanzapine and start Lorazepam ☐ J. Stop Olanzapine and start Lithium

Answer 91

i

Question 92

Q.92 Level II evidence as a mood stabiliser when combined with fluoxetine. Select ONLY ONE checkbox per page. ☐ A. Aripiprazole ☐ B. Citalopram ☐ C. Clozapine ☐ D. Fluoxetine ☐ E. Nortriptyline ☐ F. Olanzapine ☐ G. Quetiapine ☐ H. Risperidone ☐ I. Sertraline ☐ J. Venlafaxine

Answer 92

f

Question 93

Q.93 A 76 year old man develops a progressive condition causing drooling and micrographia. Select ONLY ONE checkbox per page. ☐ A. Alzheimer’s dementia ☐ B. Binswanger’s disease ☐ C. Creutzfeldt-Jakob disease ☐ D. Lewy body dementia ☐ E. Parkinson’s disease ☐ F. Pick’s disease ☐ G. Vascular dementia

Answer 93

e

Question 94

Q.94 Initial target dose for Risperidone when treating first episode psychosis. Select ONLY ONE checkbox per page. ☐ A. 0.5mg – 1mg ☐ B. 1mg – 2mg ☐ C. 2mg – 3mg ☐ D. 3mg – 4mg ☐ E. 4mg – 5mg ☐ F. 5mg – 6mg

Answer 94

c

Question 95

Q.95 Issues to consider regarding treatments for bipolar depression. Select ONLY ONE checkbox per page. ☐ A. Antidepressants cause a switch to mania in 18% of cases ☐ B. Antidepressants cause a switch to mania in 38% of cases ☐ C. Antidepressants reduce the risk of rapid cycling ☐ D. ECT can cause a switch to mania ☐ E. Fluoxetine is safe to use as monotherapy ☐ F. Lamotrigine is effective for longer-term prevention, including during manic episodes ☐ G. Longer-term Lithium therapy increases the risk of suicide ☐ H. The risk of a switch to mania is reduced by the use of tricyclics

Answer 95

d

Question 96

Q.96 Argued that male identification is defined by rejection rather than acceptance. Select ONLY ONE checkbox per page. ☐ A. Alfred Adler ☐ B. Anna Freud ☐ C. Erich Fromm ☐ D. Ernest Jones ☐ E. Harry Guntrip ☐ F. Heinz Kohut ☐ G. Karen Horney ☐ H. Mary Ainsworth ☐ I. Nancy Chodorow ☐ J. Otto Rank

Answer 96

i

Question 97

Q.97 A psychiatrist over-rides a patient’s instruction not to contact her parents, due to concerns about the risk of her suiciding. Select ONLY ONE checkbox per page. ☐ A. Autonomy ☐ B. Beneficence ☐ C. Justice ☐ D. Non-maleficence ☐ E. The right not to be abused ☐ F. The right to be treated without prejudice or bias ☐ G. The right to be informed about one’s treatment ☐ H. The right to be treated with dignity ☐ I. The right to privacy

Answer 97

b

Question 98

Q.98 “There are messages in car number plates about the conspiracy. It’s the androids – I have to stop them taking over.” Select ONLY ONE checkbox per page. ☐ A. Delusion of guilt ☐ B. Delusion of control ☐ C. Grandiose delusion ☐ D. Idea of reference ☐ E. Mood congruent delusion ☐ F. Nihilistic delusion ☐ G. Overvalued idea ☐ H. Preoccupation ☐ I. Referential delusion ☐ J. Somatic delusion

Answer 98

i

Question 99

Q.99 The most rapidly addictive activity. Select ONLY ONE checkbox per page. ☐ A. Casino-based blackjack ☐ B. Casino-based roulette ☐ C. Greyhound racing betting ☐ D. Horse racing betting ☐ E. On-line poker ☐ F. On-line mah jong ☐ G. Pokie machines ☐ H. Visiting internet social sites

Answer 99

g

Question 100

Q.100 Moira, a 76-year-old woman, is referred to you with depression. Her husband complains that she is having difficulty finding words and that she no longer cares for herself properly. Moira is dishevelled, with food stains on her blouse of which she seems unaware. Her speech shows poverty of content and paraphasias. She loses several points on cognitive assessment, with good short-term recall but inability to copy diagrams accurately or to write a proper sentence. Select ONLY ONE checkbox per page. ☐ A. Alzheimer’s dementia ☐ B. Creutzfeld-Jakob disease ☐ C. Frontotemporal (Pick’s) dementia ☐ D. Huntingdon’s disease ☐ E. Korsakoff’s syndrome ☐ F. Lewy body dementia ☐ G. Parkinson’s disease ☐ H. Vascular dementia

Answer 100

a

Question 101

Q.101 Sheila, aged 55, accepts that giving up marmite is worth it to help manage her previously intractable depression. Select ONLY ONE checkbox per page. ☐ A. Aripiprazole ☐ B. Clozapine ☐ C. Gabapentin ☐ D. Lamotrigine ☐ E. Lithium carbonate ☐ F. Olanzapine ☐ G. Phenelzine ☐ H. Quetiapine ☐ I. Risperidone ☐ J. Sodium valproate

Answer 101

g

Question 102

Q.102 Medication which is not considered a first line treatment for those with first episode non-affective psychosis. Select ONLY ONE checkbox per page. ☐ A. Amisulpride ☐ B. Aripiprazole ☐ C. Olanzapine ☐ D. Quetiapine ☐ E. Risperidone ☐ F. Ziprasidone

Answer 102

c

Question 103

Q.103 “It’s just like riding a bike.” Select ONLY ONE checkbox per page. ☐ A. Episodic Memory ☐ B. Facial Memory ☐ C. Paradigms ☐ D. Procedural Memory ☐ E. Semantic Memory ☐ F. Short-Term Memory ☐ G. Verbal Memory ☐ H. Working Memory

Answer 103

d

Question 104

Q.104 Franz sees himself as the cause of a negative event for which in fact he was not primarily responsible. Select ONLY ONE checkbox per page. ☐ A. All-or-nothing thinking ☐ B. Automatic thoughts ☐ C. Catastrophising ☐ D. Disqualifying the positive ☐ E. Emotional reasoning ☐ F. Mislabelling ☐ G. Overgeneralization ☐ H. Personalization

Answer 104

h

Question 105

Q.105 Billy is aged 8. His teacher has noticed that after getting to his classroom he leaves his bag, walks back to the gate, taps the gate eight times, does a push up and clenches and unclenches his fists three times, then goes back to class to put his bag away. Select ONLY ONE checkbox per page. ☐ A. Autistic Spectrum Disorder ☐ B. Conduct Disorder ☐ C. Disruptive Mood Dysregulation Disorder ☐ D. Obsessive Compulsive Disorder ☐ E. Oppositional Defiant Disorder ☐ F. Schizophrenia ☐ G. Social anxiety disorder

Answer 105

d

Question 106

Q.106 Agnes, a 20 year old refugee, repeatedly draws figures who look vaguely like herself, but who have missing limbs or holes in their chests. Select ONLY ONE checkbox per page. ☐ A. Acceptance and commitment therapy ☐ B. Behavioural therapy ☐ C. Brief psychodynamic therapy ☐ D. Cognitive behavioural therapy ☐ E. Expressive therapy ☐ F. Interpersonal therapy ☐ G. Play therapy ☐ H. Psychodrama

Answer 106

e

Question 107

Q.107 Which statement below is not correct, regarding Aboriginal and Torres Islander peoples and their health. Select ONLY ONE checkbox per page. ☐ A. Aboriginal and Torres Islander peoples have a holistic view of health. ☐ B. Finding out about traditional laws can play a big part in whether an assessment goes well or poorly. ☐ C. Psychiatrists need to recognise the history of physical and psychological genocide and extreme trauma affecting Aboriginal and Torres Strait Islander communities. ☐ D. Psychiatrists who do not themselves have Aboriginal or Torres Islander ancestry should read as much as possible about Aboriginal and Torres Islander cultural beliefs and practices so they can become experts in this field. ☐ E. ‘The Dance of Life’ is a series of paintings of the many dimensions in a comprehensive approach to understand Aboriginal and Torres Strait Islander mental health. ☐ F. The RANZCP has apologised to Aboriginal and Torres Strait Islander peoples for the failure of the medical profession to intervene in the disastrous “Stolen generation” practices. ☐ G. There are a very large number of Aboriginal tribes, whose languages are diverse. ☐ H. Understanding kinship systems is important when working with Aboriginal and Torres Islander peoples.

Answer 107

d

Question 108

Q.108 Jodie tells her psychotherapist that she’s started seeing a naturopath every week who is “really understanding and helpful. It’s such a relief to get practical advice.” Select ONLY ONE checkbox per page. ☐ A. Countertransference ☐ B. Idealisation and devaluation ☐ C. Intellectualisation ☐ D. Negative transference ☐ E. Positive transference ☐ F. Rationalisation ☐ G. Reaction formation ☐ H. Repression

Answer 108

b

Question 109

Q.109 A 4 year old child presents to ED with opisthotonus after ingesting her mother’s metoclopramide tablets. Select ONLY ONE checkbox per page. ☐ A. Cerebellum ☐ B. Frontal cortex ☐ C. Hypothalamus ☐ D. Nigrostriatal system ☐ E. Right temporal area ☐ F. Spinothalamic pathway ☐ G. Temporal cortex ☐ H. Tuberoinfundibular pathway

Answer 109

d

Question 110

Q.110 Regarding people with Intellectual disability (ID), which of the following is not correct Select ONLY ONE checkbox per page. ☐ A. 99% of people with Down’s Syndrome develop Alzheimer’s Disease by age 40 ☐ B. ID is defined as: IQ <70, functional impairments in at least two areas of life, and onset before age 18 ☐ C. Mild ID is defined as an IQ between 50–70 ☐ D. Moderate ID is defined as an IQ between 35–49 ☐ E. Of people with ID, 30% have additional visual disability ☐ F. Of people with ID, 40% have additional hearing disability ☐ G. People with ID are more vulnerable to mental disorders due to histories of abuse, adverse life events, and lack of protective experiences ☐ H. The incidence of suicide, drug & alcohol problems and personality disorders is higher in people with ID

Answer 110

h

Question 111

Q.111 A 32 year old woman discusses her belief in the sixth sense, is circumstantial in her thinking and claims that the interviewer wore a certain ring because they knew she would like it. Select ONLY ONE checkbox per page. ☐ A. Brief Psychotic Disorder ☐ B. Delusional Disorder ☐ C. Narcissistic Personality disorder ☐ D. Major Depressive Disorder ☐ E. Obsessive Compulsive Disorder ☐ F. Paranoid Personality disorder ☐ G. Schizoaffective Disorder ☐ H. Schizophrenia ☐ I. Schizophreniform Disorder ☐ J. Schizotypal Personality Disorder ☐ K. Schizoid Personality Disorder

Answer 111

j

Question 112

Q.112 Mrs Vodanovic suddenly develops an inability to speak during a bitter family dispute over her father’s will. Her family bring her to the GP but she herself does not seem distressed. Select ONLY ONE checkbox per page. ☐ A. Catatonia ☐ B. Conversion disorder ☐ C. Elective mutism ☐ D. Fluent Dysphasia ☐ E. Guardedness ☐ F. Non-fluent dysphasia ☐ G. Passive-aggressive witholding ☐ H. Poverty of the content of speech ☐ I. Psychomotor retardation

Answer 112

b

Question 113

Q.113 Most effective follow-up therapy after a course of ECT for a patient with a serious major depression with melancholic features. Select ONLY ONE checkbox per page. ☐ A. Cognitive behavioural therapy and Fluoxetine ☐ B. Doxepin ☐ C. Doxepin and Sodium Valproate ☐ D. Lamotragine ☐ E. Lithium carbonate ☐ F. Mirtazepine ☐ G. Nortriptyline ☐ H. Nortriptyline and Lithium Carbonate ☐ I. Tranylcypromine ☐ J. Venlafaxine

Answer 113

h

Question 114

Q.114 William, an 80-year-old man with no psychiatric history, presents with a two-month history of low mood, isolativeness, visual hallucinations and nihilistic ruminations. Over the past month he has become almost mute, and bed-bound. Myoclonic jerks are observed, and an electroencephalogram (EEG) shows sharp wave complexes. Select ONLY ONE checkbox per page. ☐ A. Alzheimer’s dementia ☐ B. Creutzfeld-Jakob disease ☐ C. Frontotemporal (Pick’s) dementia ☐ D. Huntingdon’s disease ☐ E. Lewy body dementia ☐ F. Neurosyphilis ☐ G. Parkinson’s disease ☐ H. Vascular dementia ☐ I. Wernicke’s encephalopathy

Answer 114

b

Question 115

Q.115 A 35 year old man with a history of severe psychotic manic episodes developed neuroleptic malignant syndrome a year ago while on lithium and risperidone, and has been on no treatment for the last six months. He has now developed manic symptoms and has received high-dose oral quetiapine and intramuscular lorazepam for the last three days. Select ONLY ONE checkbox per page. ☐ A. Electrocardiogram ☐ B. Fasting serum glucose ☐ C. Full blood count ☐ D. Liver function tests ☐ E. Serum creatinine ☐ F. Serum creatinine kinase ☐ G. Temperature

Answer 115

g

Question 116

Q.116 After separating from her husband, Sandra is acutely sensitive to feeling criticized, sleeps more than usual and eats more high calorie junk food than usual. Select ONLY ONE checkbox per page. ☐ A. Anorexia nervosa ☐ B. Atypical depression ☐ C. Binge eating disorder ☐ D. Bipolar disorder type II ☐ E. Bulimia nervosa ☐ F. Comfort eating ☐ G. Dysthymic disorder ☐ H. Eating disorder NOS

Answer 116

b

Question 117

Q.117 Tryptophan hydroxylase is the enzyme involved in the rate-limiting step in the synthesis of this neurotransmitter. Select ONLY ONE checkbox per page. ☐ A. 5-hydroxy indole acetic acid (5-HIAA) ☐ B. Acetylcholine ☐ C. Dopamine ☐ D. Gamma-aminobutyric acid (GABA) ☐ E. Glutamate ☐ F. Glycine ☐ G. Noradrenaline ☐ H. Serotonin

Answer 117

h

Question 118

Q.118 Aya is a 60 year old immigrant who was brought here by her extended family a year ago. They regard her as “slow” and she has been kept secluded, at home. She presents after developing delusions of being poisoned, and on assessment is noted to have a puffy face, long latency in replies and cognitive deficits. Select ONLY ONE checkbox per page. ☐ A. Cushings disease ☐ B. Graves disease ☐ C. Hyperparathyroidism ☐ D. Hyperthyroidism ☐ E. Hypothyroidism ☐ F. Liver failure ☐ G. Renal failure ☐ H. Wilson’s disease

Answer 118

e

Question 119

Q.119 Mr Barker, aged 83, has such speech latency that he begins to reply only when the interviewer asks the next question. He makes no eye contact and has lost considerable weight. Select ONLY ONE checkbox per page. ☐ A. Alzheimer’s dementia ☐ B. Catatonia ☐ C. Conversion disorder ☐ D. Elective mutism ☐ E. Normal pressure hydrocephalus ☐ F. Parkinson’s disease ☐ G. Psychomotor retardation ☐ H. Schizophrenia

Answer 119

g

Question 120

Q.120 Joe, aged 32, has a history of recurrent depression and hypomania. He is admitted with an acute psychosis and becomes incoherent. Shortly afterwards he is found mute and immobile, standing upright but leaning at an odd angle. Select ONLY ONE checkbox per page. ☐ A. Catatonic schizophrenia ☐ B. Disorganised schizophrenia ☐ C. Malignant catatonia ☐ D. Manic stupor ☐ E. Melancholic depression ☐ F. Psychotic depression ☐ G. Schizoaffective disorder

Answer 120

d

Question 121

Q.121 A 41 year old man with schizophrenia is stable on clozapine, with good symptom control five months after commencing this. Select ONLY ONE checkbox per page. ☐ A. A fasting blood glucose level 3-monthly ☐ B. A monthly ECG ☐ C. An annual AIMs test ☐ D. Annual girth measurements ☐ E. Annual thyroid function tests ☐ F. Full blood count and differential monthly ☐ G. Full blood count and differential weekly ☐ H. Monthly serum levels of the medication ☐ I. Serum lipids annually ☐ J. Three-monthly HB1AC blood tests

Answer 121

f

Question 122

Q.122 Government funding to mental health services is “ring fenced” to ensure the health service cannot use it to fund other specialties. Select ONLY ONE checkbox per page. ☐ A. Autonomy ☐ B. Beneficence ☐ C. Justice ☐ D. Non-maleficence ☐ E. The right not to be abused ☐ F. The right to be treated without prejudice or bias ☐ G. The right to be informed about one’s treatment ☐ H. The right to be treated with dignity ☐ I. The right to privacy

Answer 122

c

Question 123

Q.123 Maria is ordered to see a budgetary advisor and loses her job as a sales clerk due to theft. Select ONLY ONE checkbox per page. ☐ A. Alcohol abuse ☐ B. Alcohol dependence ☐ C. Heroin dependence ☐ D. Inhalant abuse ☐ E. Internet addiction ☐ F. Lorazepam dependence ☐ G. Pathological gambling ☐ H. Stimulant abuse

Answer 123

g

Question 124

Q.124 Richard, a 72-year-old man with a history of past Coronary Artery Bypass Graft surgery and leg pain on walking, is referred as his wife has noticed problems with his short-term memory. Richard says that he copes by making lists. He presents as a pleasant and sociable man and scores 21/30 on a Mini Mental State Examination. Select ONLY ONE checkbox per page. ☐ A. Alzheimer’s dementia ☐ B. Creutzfeld-Jakob disease ☐ C. Frontotemporal (Pick’s) dementia ☐ D. Huntingdon’s disease ☐ E. Lewy body dementia ☐ F. Parkinson’s disease ☐ G. Vascular dementia

Answer 124

g

Question 125

Q.125 Ray decides to cease penicillamine and starts naturopathy instead. Six months later he is admitted with a manic psychosis and cognitive deficits. Select ONLY ONE checkbox per page. ☐ A. Cushings disease ☐ B. Graves disease ☐ C. Hypothyroidism ☐ D. Liver failure ☐ E. Phaeochromocytoma ☐ F. Porphyria ☐ G. Renal failure ☐ H. SIADH ☐ I. Wilson’s disease

Answer 125

i

Question 126

Q.126 A young man is repeatedly admitted with relapses after stopping clozapine. The relapses always have the same pattern of symptoms, with muteness, echopraxia and waxy flexibility. Select ONLY ONE checkbox per page. ☐ A. Catatonic schizophrenia ☐ B. Disorganised schizophrenia ☐ C. Malignant catatonia ☐ D. Manic stupor ☐ E. Melancholic depression ☐ F. Neuroleptic malignant syndrome ☐ G. Psychotic depression ☐ H. Schizoaffective disorder

Answer 126

a

Question 127

Q.127 The main morphological findings in human postmortem studies of schizophrenia. Select ONLY ONE checkbox per page. ☐ A. Decreased hippocampal volume ☐ B. Enlargement of ventricles ☐ C. Increased neuronal density in Brodman areas 9 and 46 ☐ D. Increased thalamic volume ☐ E. Reduction in dendritic spaces ☐ F. Slight cortical thinning in prefrontal cortex

Answer 127

d

Question 128

Q.128 Benjy is a 13 year old boy with a long history of ADHD, which is considered well treated on Methylphenidate LA. He has developed a major depression episode with marked loss of appetite and sleep disruption, which his mother ascribes to difficulties with learning and a family history of depression. Select ONLY ONE checkbox per page. ☐ A. Atomoxetine ☐ B. Caffeine ☐ C. Citalopram ☐ D. Concerta (Methylphenidate XR) ☐ E. Dexamphetamine ☐ F. Fluoxetine ☐ G. Melatonin ☐ H. Modafinil ☐ I. Risperidone

Answer 128

f

Question 129

Q.129 Jitteriness, poor feeding, hypotonia and tachypnoea in neonates Select ONLY ONE checkbox per page. ☐ A. Benztropine ☐ B. Gabapentine ☐ C. Lithium carbonate ☐ D. Olanzapine ☐ E. Paroxetine ☐ F. Quetiapine ☐ G. Risperidone ☐ H. Tranylcypromine

Answer 129

e

Question 130

Q.130 A qualitative study describing and analysing organisational change during the restructuring of a maternal mental health service, across one year. Select ONLY ONE checkbox per page. ☐ A. Constant Comparative Analysis ☐ B. Data collection using documentation ☐ C. Data collection using focus groups ☐ D. Data collection using semi-structured interviews ☐ E. Ethnographic qualitative research ☐ F. Extended case study ☐ G. Grounded Theory ☐ H. Phenomenological qualitative research

Answer 130

f

Question 131

Q.131 Requires the client to have clearly defined goals and minimal resistance. Select ONLY ONE checkbox per page. ☐ A. Adherence therapy ☐ B. Brief psychodynamic psychotherapy ☐ C. Cognitive behavioural therapy ☐ D. Dialectical behavioural therapy ☐ E. Exposure and response prevention ☐ F. Interpersonal therapy ☐ G. Motivational interviewing ☐ H. Solution-focussed therapy ☐ I. Supportive therapy ☐ J. Systematic desensitisation

Answer 131

b

Question 132

Q.132 A woman being treated for persistent depression develops fever, fatigue and mouth ulceration. Select ONLY ONE checkbox per page. ☐ A. Aripiprazole ☐ B. Clozapine ☐ C. Gabapentin ☐ D. Lamotrigine ☐ E. Lithium carbonate ☐ F. Olanzapine ☐ G. Phenelzine ☐ H. Quetiapine ☐ I. Risperidone ☐ J. Sodium valproate

Answer 132

d

Question 133

Q.133 Which of the following is not a diagnostic feature of Borderline Personality Disorder. Select ONLY ONE checkbox per page. ☐ A. Affective instability ☐ B. Chronic feelings of emptiness ☐ C. Difficulty controlling anger ☐ D. Dissociative symptoms ☐ E. Disturbed Identity ☐ F. Efforts to avoid abandonment ☐ G. Impulsivity in areas that are self-damaging ☐ H. Recurrent suicidal (or self-mutilating) behaviour ☐ I. Stress related paranoid ideation ☐ J. Suggestibility ☐ K. Unstable and intense relationships

Answer 133

j

Question 134

Q.134 Miriam can name three female Prime Ministers of New Zealand. Select ONLY ONE checkbox per page. ☐ A. Episodic Memory ☐ B. Facial Memory ☐ C. Imagery ☐ D. Paradigms ☐ E. Procedural Memory ☐ F. Semantic Memory ☐ G. Short-Term Memory ☐ H. Verbal Memory ☐ I. Visual Memory ☐ J. Working Memory

Answer 134

f

Question 135

Q.135 Winner of the Nobel Prize in 1927 for discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica. Select ONLY ONE checkbox per page. ☐ A. Carl Jung ☐ B. Emil Kraepelin ☐ C. Eugene Bleuler ☐ D. Franz Gall ☐ E. Hideyo Noguchi ☐ F. Julius Wagner-Jauregg ☐ G. Karl Menninger ☐ H. Ugo Cerletti

Answer 135

f

Question 136

Q.136 A young woman kills her mother, convinced that she is an impostor and a spy. Select ONLY ONE checkbox per page. ☐ A. Actus reus ☐ B. Disease of the mind ☐ C. Duress ☐ D. Fitness to plead ☐ E. Forseeability ☐ F. Irresistible impulse ☐ G. Mens rea ☐ H. Natural Justice ☐ I. Provocation ☐ J. Sane Automatism

Answer 136

b

Question 137

Q.137 Increased risk of late-onset Alzheimer’s disease. Select ONLY ONE checkbox per page. ☐ A. 5HTT gene L genotype ☐ B. 5HTT gene S genotype ☐ C. Apolipoprotein gene (APOE e4 allele) ☐ D. D-amino acid oxidase activator (DAOA) ☐ E. Neuregulin gene (NRG1) ☐ F. Neurogenic locus notch 4 (NOTCH4) ☐ G. Reelin gene (REELIN)

Answer 137

c

Question 138

Q.138 Which of the following is not true, when working with an interpreter. Select ONLY ONE checkbox per page. ☐ A. Family members may not be able to interpret accurately for a number of reasons. ☐ B. Interpreters for the deaf should be seated beside the clinician. ☐ C. Interpreters must adhere to strict confidentiality. ☐ D. Interpreters should not have side conversations with the patient or family. ☐ E. Interpreters should preferentially use the ‘triangle’ model of interpretation. ☐ F. Interpreters should preferentially use the ‘black box’ model of interpretation. ☐ G. When working with an interpreter, speak directly to the patient.

Answer 138

f

Question 139

Q.139 Keratinocyte apoptosis. Select ONLY ONE checkbox per page. ☐ A. Acute laryngeal dystonia ☐ B. Anticholinergic delirium ☐ C. Fatal carbon monoxide poisoning ☐ D. Fatal paracetamol overdose ☐ E. Heavy cigarette smoking ☐ F. Lithium toxicity ☐ G. Opiate toxicity ☐ H. Stevens-Johnson syndrome

Answer 139

h

Question 140

Q.140 Elias is a 14 year old boy with significant autistic spectrum features and an IQ of 72. He has devoted parents who have worked hard on behavioural routines. Since puberty, they have been struggling with increasing episodes of irritability when his needs are not met immediately and have asked about medication options. Select ONLY ONE checkbox per page. ☐ A. Atomoxetine ☐ B. Caffeine ☐ C. Citalopram ☐ D. Concerta (Methylphenidate XR) ☐ E. Dexamphetamine ☐ F. Fluoxetine ☐ G. Modafinil ☐ H. Olanzapine ☐ I. Risperidone

Answer 140

i

Question 141

CAP Question 1 (20 marks) Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis Summary Background: Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder. Methods: We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies’ risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. Select ONLY ONE checkbox per page. Question 1.1 Based on the adjoining abstract and your other knowledge, please answer the following question. Which option best describes this study? (1 mark) ☐ A. Aetiological ☐ B. Interventional ☐ C. Meta-analysis ☐ D. Observational ☐ E. Prognositic ☐ F. Qualitative ☐ G. Screening intervention ☐ H. Systematic review (abstract continues on next page)

Answer 141

c

Question 142

CAP Question 1 contd. Findings: We identified 28,552 citations and of these included 522 trials comprising 116,477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2.13 (95% credible interval [CrI] 1.89–2.41) for amitriptyline and 1.37 (1.16–1.63) for reboxetine. For acceptability, only agomelatine (OR 0.84, 95% CrI 0.72–0.97) and fluoxetine (0.88, 0.80–0.96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1.30, 1.01–1.68). When all trials were considered, differences in ORs between antidepressants ranged from 1.15 to 1.55 for efficacy and from 0.64 to 0.83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1.19–1.96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0.51–0.84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0.43–0.77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1.30–2.32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low. Interpretation: All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants. Select ONLY ONE checkbox per page. Question 1.2 Based on the adjoining abstract and your other knowledge, please answer the following question. Which option best describes the main study screening process? (2 marks) ☐ A. Contacting individual study authors ☐ B. Manual search ☐ C. Narrative review ☐ D. Regulatory agencies enquiry ☐ E. Scoping review ☐ F. Systematic literature search ☐ G. Trial registry search

Answer 142

f

Question 143

Select ONLY ONE checkbox per page. Question 1.3 Based on the adjoining abstract and your other knowledge, please answer the following question. Which option best describes the double-blind nature of the included studies? (2 marks) ☐ A. A study in which participants and their family are unaware of whether participants are receiving treatment with the active drug or placebo. ☐ B. A study in which treatment providers and researchers are unaware of whether participants are receiving treatment with the active drug or placebo. ☐ C. A study in which participants are unaware of whether they are receiving treatment with the active drug or placebo. ☐ D. A study in which the participants and researchers are unaware whether the participants are receiving treatment with the active drug or placebo. ☐ E. A study in which the researchers and data analysts are unware whether the participants are receiving treatment with the active drug or placebo. ☐ F. A study in which the participants and data analysts are unaware whether the participants are receiving treatment with the active drug or placebo.

Answer 143

d

Question 144

Select ONLY ONE checkbox per page. Question 1.4 Based on the adjoining figure(network metanalysis) and your other knowledge, please answer the following question. Which option below best describes the principal advantage of network meta-analyses? (2 marks) ☐ A. Allows direct comparisons between treatments of interest. ☐ B. Analyses longitudinal cohort data to make inferences about causation. ☐ C. Compares treatments of interest when direct comparisons are not present through the use of a common comparator or linking treatment. ☐ D. Ensures unpublished, often negative studies are included in the analysis. ☐ E. Excludes those who do not adhere to treatment. ☐ F. Increases the statistical power.

Answer 144

c

Question 145

In terms of efficacy, all antidepressants were more effective in achieving remission than placebo, with Odds Ratios ranging between 2.13 for amitriptyline and 1.37 for reboxetine. Select ONLY ONE checkbox per page. Question 1.5 Based on the adjoining abstract and your other knowledge, please answer the following question. Which option best describes the Odds Ratio calculation? (2 marks) ☐ A. A measure of the strength of the association. ☐ B. The inverse of the absolute risk reduction. ☐ C. The odds of achieving remission for antidepressants divided by the odds of achieving remission in placebo. ☐ D. The proportion of patients who have responded over a given time period. ☐ E. The rate of remission for antidepressants minus the rate of remission for placebo. ☐ F. The ratio of achieving remission for antidepressants divided by the ratio of achieving remission in placebo.

Answer 145

c

Question 146

Select ONLY ONE checkbox per page.

Question 1.6 Based on the adjoining figure A and your other knowledge, please answer the following question. Which statement about efficacy is most accurate? (2 marks)

☐

Amitriptyline is significantly more efficacious than Mirtazapine.

☐

Amitriptyline is the antidepressant of first choice.

☐

Clomipramine is significantly less effective than Agomelatine.

☐

Clomipramine is the least efficacious antidepressant.

☐

Reboxetine is significantly less efficacious than Amitriptyline.

☐

Reboxetine is significantly more efficacious than Amitriptyline.

☐

Reboxetine is the weakest antidepressant.

(if text size in the adjoining figure is too small, click on the zoom control at lower right of the screen to enlarge the view)

Answer 146

Reboxetine is significantly less efficacious than Amitriptyline.

Question 147

Question 1.7 Based on the adjoining figure B and your other knowledge, please answer the following question. Which statement about acceptability is most accurate? (2 marks)

☐

Agomelatine is significantly more acceptable than Clomipramine

☐

Agomelatine is significantly more acceptable than Fluoxetine

☐

Agomelatine is the antidepressant of first choice

☐

Amitriptyline is significantly more acceptable than Reboxetine

☐

Amitriptyline is the most acceptable medication

Clomipramine is significantly more acceptable than

☐

Amitriptyline

Clomipramine is significantly more acceptable than placebo

Answer 147

Agomelatine is significantly more acceptable than Clomipramine

Question 148

Select ONLY ONE checkbox per page.

Question 1.8 Based on the adjoining figure and your other knowledge, please answer the following question. Which statement about funnel plots is most accurate? (2 marks)

☐

Between study heterogeneity is not a cause of funnel plot asymmetry.

☐

Chance findings do not cause funnel plot asymmetry.

☐

Consistent negative findings between active treatment and placebo causes funnel plot asymmetry.

☐

Fraudulent reporting of study results is not a cause of funnel plot asymmetry.

☐

Non-publication of smaller negative studies is a cause of funnel plot asymmetry.

☐

Reporting bias does not cause funnel plot asymmetry.

☐

Reporting studies with large variation in sample sizes causes funnel plot asymmetry.

Answer 148

Non-publication of smaller negative studies is a cause of funnel plot asymmetry

Question 149

Overall, 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low.

Select ONLY ONE checkbox per page.

Question 1.9 Based on the adjoining abstract excerpt and your other knowledge, please answer the following question. Which statement about risk of bias is most accurate? (2 marks)

☐

Failure to blind assessors increases risk of bias.

☐

Lack of randomisation reduces risk of bias.

☐

Similar findings from a series of studies reduces risk of bias.

☐

The author/s of the study assess risk of bias based on their qualitative impression.

☐

The drop out of non-responders will reduce risk of bias.

☐

The lead author of the study is best placed to complete the risk of bias assessment.

Answer 149

Failure to blind assessors increases risk of bias.

Question 150

The quality of many comparisons was assessed as low or very low for amitriptyline, bupropion, and venlafaxine, whereas it was often rated as moderate for agomelatine, escitalopram, and mirtazapine

Question 1.10 Based on the adjoining abstract excerpt and your other knowledge, please answer the following question. Which statement about quality of evidence is most accurate? (1 mark)

☐

A case series from a dedicated clinician is more informative than a case-control study.

☐

A systematic review of RCTs provides high level evidence to inform medical decision making.

☐

Expert opinion provides the best quality evidence for medical decision making.

☐

Several medium scale RCTs provide more useful information than one large RCT for informing medical decision making.

☐

The management of rare conditions is best evaluated with large scale RCTs.

Answer 150

A systematic review of RCTs provides high level evidence to inform medical decision making.

Question 151

We included double-blind, randomised controlled trials (RCTs) comparing antidepressants with placebo or another active antidepressant as oral monotherapy for the acute treatment of adults (≥18 years old and of both sexes) with a primary diagnosis of major depressive disorder according to standard operationalised diagnostic criteria (Feighner criteria, Research Diagnostic Criteria, DSM-III, DSM-III-R, DSM-IV, DSM-5, and ICD-10). We considered only double-blind trials because we included placebo in the network meta-analysis, and because this study design increases methodological rigour by minimising performance and ascertainment biases.

Additionally, we included all second-generation antidepressants approved by the regulatory agencies in the USA, Europe, or Japan: agomelatine, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine, vilazodone, and vortioxetine. To inform clinical practice globally, we selected the two tricyclics (amitriptyline and clomipramine) included in the WHO Model List of Essential Medicines). We also included trazodone and nefazodone, because of their distinct effect and tolerability profiles. Additionally, we included trials that allowed rescue medications so long as they were equally provided among the randomised groups. We included data only for drugs within the therapeutic range (appendix pp 133, 134). Finally, we excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness.

Question 1.11 Based on the adjoining abstract excerpt and your other knowledge, please answer the following question. A factor most likely to limit the generalisability of these results to your own clinical work would be? (2 marks)

☐

Clinicians often combine other agents (such as hypnotics) with antidepressants to provide immediate symptom relief.

☐

Patients recruited into studies such as those included tend to be highly selected.

☐

Patients with bipolar depression likely contaminated the study results.

☐

Relevant antidepressant medications weren’t included in the analysis.

☐

Study lacked power to demonstrate meaningful results.

☐

The doses of antidepressant medications used would be likely to differ from those in Australasian practice.

☐

The grey literature wasn’t taken into consideration.

Answer 151

Patients recruited into studies such as those included tend to be highly selected

Question 152

Nicotine metabolite ratio predicts smoking topography:
The Pennsylvania Adult Smoking Study

Abstract

Background: The nicotine metabolite ratio (NMR) as measured by the ratio of 3′hydroxycotinine to cotinine has been examined in relation to tobacco use patterns including cigarettes per day and quit success to determine its role in nicotine dependence. We examined the NMR in relation to smoking topography and tested the hypothesis that normal metabolizers have a greater total daily puff volume than slow metabolizers.

Methods: The Pennsylvania Adult Smoking Study (PASS) is a longitudinal study of 352 adults who smoked, on average, 17 cigarettes per day. Subjects used a portable smoking topography device over a two-day period at home and at work. We measured the ratio of 3′hydroxycotinine to cotinine in the saliva of the subjects.

Results: In multiple linear regression analyses, a higher rate of nicotine metabolism was significantly associated with increased daily puffs and total daily puff volume. In a mediation analysis, a significant, indirect effect of race on the relationship between NMR and puff volume was observed, with 22% of the effect mediated by white race. A higher NMR was also associated with female gender, white race, cigarettes per day and nicotine dependence measures.

Conclusion: The NMR was associated with tobacco use patterns including smoking topography. Faster nicotine metabolism was associated with greater total daily puffs and puff volume.

Note: “Smoking topography is a representation of the physical characteristics of smoking behaviour, such as puff count, puff volume, average flow, puff duration, and inter-puff interval.”

Nicotine metabolite ratio predicts smoking topography:
The Pennsylvania Adult Smoking Study

• Allshine Chen, Nicolle M. Krebs, Junjia Zhu, Joshua E. Muscat.*
• Department of Public Health Sciences, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA*

Abstract

Background: The nicotine metabolite ratio (NMR) as measured by the ratio of 3′hydroxycotinine to cotinine has been examined in relation to tobacco use patterns including cigarettes per day and quit success to determine its role in nicotine dependence. We examined the NMR in relation to smoking topography and tested the hypothesis that normal metabolizers have a greater total daily puff volume than slow metabolizers.

Methods: The Pennsylvania Adult Smoking Study (PASS) is a longitudinal study of 352 adults who smoked, on average, 17 cigarettes per day. Subjects used a portable smoking topography device over a two-day period at home and at work. We measured the ratio of 3′hydroxycotinine to cotinine in the saliva of the subjects.

Results: In multiple linear regression analyses, a higher rate of nicotine metabolism was significantly associated with increased daily puffs and total daily puff volume. In a mediation analysis, a significant, indirect effect of race on the relationship between NMR and puff volume was observed, with 22% of the effect mediated by white race. A higher NMR was also associated with female gender, white race, cigarettes per day and nicotine dependence measures.

Conclusion: The NMR was associated with tobacco use patterns including smoking topography. Faster nicotine metabolism was associated with greater total daily puffs and puff volume.

Note: “Smoking topography is a representation of the physical characteristics of smoking behaviour, such as puff count, puff volume, average flow, puff duration, and inter-puff interval.”

Select ONLY ONE checkbox per page.

Question 2.1 Based on the adjoining abstract and your other knowledge, please answer the following question.

Which statement best describes the design of this study? (1 mark)

☐

Case-control study

☐

Cohort study

☐

Cross sectional study

☐

Prospective study

☐

Pseudorandomised control study

☐

Randomised controlled trial

☐

Systematic review

Answer 152

Prospective study

Question 153

Nicotine metabolite ratio predicts smoking topography:
The Pennsylvania Adult Smoking Study

Abstract

Background: The nicotine metabolite ratio (NMR) as measured by the ratio of 3′hydroxycotinine to cotinine has been examined in relation to tobacco use patterns including cigarettes per day and quit success to determine its role in nicotine dependence. We examined the NMR in relation to smoking topography and tested the hypothesis that normal metabolizers have a greater total daily puff volume than slow metabolizers.

Methods: The Pennsylvania Adult Smoking Study (PASS) is a longitudinal study of 352 adults who smoked, on average, 17 cigarettes per day. Subjects used a portable smoking topography device over a two-day period at home and at work. We measured the ratio of 3′hydroxycotinine to cotinine in the saliva of the subjects.

Results: In multiple linear regression analyses, a higher rate of nicotine metabolism was significantly associated with increased daily puffs and total daily puff volume. In a mediation analysis, a significant, indirect effect of race on the relationship between NMR and puff volume was observed, with 22% of the effect mediated by white race. A higher NMR was also associated with female gender, white race, cigarettes per day and nicotine dependence measures.

Conclusion: The NMR was associated with tobacco use patterns including smoking topography. Faster nicotine metabolism was associated with greater total daily puffs and puff volume.

Note: “Smoking topography is a representation of the physical characteristics of smoking behaviour, such as puff count, puff volume, average flow, puff duration, and inter-puff interval.”

Nicotine metabolite ratio predicts smoking topography:
The Pennsylvania Adult Smoking Study

Allshine Chen, Nicolle M. Krebs, Junjia Zhu, Joshua E. Muscat.
Department of Public Health Sciences, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA

Abstract

Background: The nicotine metabolite ratio (NMR) as measured by the ratio of 3′hydroxycotinine to cotinine has been examined in relation to tobacco use patterns including cigarettes per day and quit success to determine its role in nicotine dependence. We examined the NMR in relation to smoking topography and tested the hypothesis that normal metabolizers have a greater total daily puff volume than slow metabolizers.

Methods: The Pennsylvania Adult Smoking Study (PASS) is a longitudinal study of 352 adults who smoked, on average, 17 cigarettes per day. Subjects used a portable smoking topography device over a two-day period at home and at work. We measured the ratio of 3′hydroxycotinine to cotinine in the saliva of the subjects.

Results: In multiple linear regression analyses, a higher rate of nicotine metabolism was significantly associated with increased daily puffs and total daily puff volume. In a mediation analysis, a significant, indirect effect of race on the relationship between NMR and puff volume was observed, with 22% of the effect mediated by white race. A higher NMR was also associated with female gender, white race, cigarettes per day and nicotine dependence measures.

Conclusion: The NMR was associated with tobacco use patterns including smoking topography. Faster nicotine metabolism was associated with greater total daily puffs and puff volume.

Note: “Smoking topography is a representation of the physical characteristics of smoking behaviour, such as puff count, puff volume, average flow, puff duration, and inter-puff interval.”

Select ONLY ONE checkbox per page.

Question 2.2 Based on the adjoining abstract and your other knowledge, please answer the following question.

This trial was designed to measure the differences in: (1 mark)

☐

3′hydroxycotinine in smokers

☐

NMR in tobacco users

☐

Puff volume between normal and fast metabolisers

☐

Quit success in smokers

☐

Smoking cessation differences between slow and fast metabolisers

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Smoking topography between normal and slow metabolisers

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Tobacco use patterns in smokers

Answer 153

Smoking topography between normal and slow metabolisers

Question 154

The Pennsylvania Adult Smoking Study (PASS), a study of smoke exposure and nicotine dependence, was conducted in central Pennsylvania between June 2012 and April 2014. Study participants were recruited through local radio advertisements, through flyers posted in places smokers frequent (i.e., gas stations, convenience stores, and tobacco shops), and through the Internet and social media. Recruitment was also facilitated by word of mouth from past participants. Eligible subjects were aged 18 years or older, had smoked at least 1 cigarette per day for the past year, and were not currently pregnant. A total of 352 participants signed the consent form and enrolled in the study. One participant did not complete the study protocol.

Question 2.3 Based on the abstract, the adjoining extract and your other knowledge, which of the following statements is true regarding the study setting: (1 mark)

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A clinical setting

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A mix of clinical and naturalistic settings

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A naturalistic based setting

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None of the above

Answer 154

naturalistic based setting

Question 155

The Pennsylvania Adult Smoking Study (PASS), a study of smoke exposure and nicotine dependence, was conducted in central Pennsylvania between June 2012 and April 2014. Study participants were recruited through local radio advertisements, through flyers posted in places smokers frequent (i.e., gas stations, convenience stores, and tobacco shops), and through the Internet and social media. Recruitment was also facilitated by word of mouth from past participants. Eligible subjects were aged 18 years or older, had smoked at least 1 cigarette per day for the past year, and were not currently pregnant. A total of 352 participants signed the consent form and enrolled in the study. One participant did not complete the study protocol.

Question 2.4Based on the abstract, the adjoining extract and your other knowledge, please answer the following question.

Patients were included this study if they: (1 mark)

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Lived in the USA and were adults and cigarette smokers

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Smoked at least 7 cigarettes per week and lived in Pennsylvania

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Smoked non-tobacco products and lived in Pennsylvania

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Smoked on a daily basis and lived in Pennsylvania

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Were aged 17 and over and lived in Pennsylvania

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Were being treated for anxiety

Answer 155

Smoked on a daily basis and lived in Pennsylvania

Question 156

The SPA-M is a portable touch-screen enabled pre-calibrated device where a cigarette is placed into a mouthpiece, and flow and pressure changes are recorded using pressure sensors. The SPA-M is batteryoperated and can be recharged by the subject with a power cord. The readings were downloaded onto a desktop computer with software that calculates the puff flow (ml/s), the number of puffs, puff duration (s), the interval between puffs (s), and puff volume (ml) after each subject’s use. A counter that keeps track of each cigarette smoked is reset for the next subject. The devices can be used continuously from subject to subject, pending any mechanical malfunction. The derived variables, total daily puff volume and total daily number of puffs, were the summation of the total cigarette puffs within a 24-hour period. Puff flow parameters that were either beyond the physiological capabilities of the smoker or resulted from movement artifact were excluded, based on previously reported suggestions (Williams et al, 2012).

Question 2.5 Based on the abstract above and your other knowledge, the SPA-M device does not measure: (2 marks)

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Aberrant flows

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Cigarettes per day

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Number of cigarettes smoked

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Quality of cigarette smoke

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Smoking topography

Answer 156

Quality of cigarette smoke

Question 157

Participants’ saliva samples were analyzed using mass spectrometry for nicotine metabolites (cotinine and 3′hydroxycotinine) as previously described (Chen et al, 2010; Krebs et al, 2016). The NMR (3′hydroxycotinine/cotinine) was derived from these measurements.

The characteristics of the sample were described using descriptive statistics, including means and standard deviations for continuous variables and frequencies and percentages for categorical variables. We determined the median NMR, where the sample was split into normal and slow metabolizers (NMR cut-off=0.359). Two-sample Wilcoxon-Mann-Whitney tests were used to look at the differences between the normal and slow metabolizers in relation to smokers’ characteristics.

Question 2.6 Based on the adjoining extract and tables, the abstract and your other knowledge, the mean NMR is: (1 mark)

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• 0. 46

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• 0. 38

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Highest in a black male

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Highest in a white female

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Highest in females of other race

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Lowest in a white male

Answer 157

Highest in a white female

Question 158

Participants’ saliva samples were analyzed using mass spectrometry for nicotine metabolites (cotinine and 3′hydroxycotinine) as previously described (Chen et al, 2010; Krebs et al, 2016). The NMR (3′hydroxycotinine/cotinine) was derived from these measurements.

The characteristics of the sample were described using descriptive statistics, including means and standard deviations for continuous variables and frequencies and percentages for categorical variables. We determined the median NMR, where the sample was split into normal and slow metabolizers (NMR cut-off=0.359). Two-sample Wilcoxon-Mann-Whitney tests were used to look at the differences between the normal and slow metabolizers in relation to smokers’ characteristics

Question 2.7 Based on the adjoining extract and tables, the abstract and your other knowledge, the total number of participants was:
(1 mark)

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299

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326

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351

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352

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652

Answer 158

326

Question 159

Question 2.8 Based on your other knowledge, which of these is not a continuous variable? (1 mark)

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Age

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BMI

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Female sex

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Nicotine metabolite ratio

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Number of cigarettes per day

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Puff duration

Answer 159

Female sex

Question 160

Question 2.9 Based on your other knowledge, which of the following assumptions must be met in an ANOVA: (2 marks)

All of these things

Random sampling of cases must have taken place

The data must be normally distributed

The dependent variable must be interval or ratio

There must be homogeneity of variance

There must be only one dependent variable

Answer 160

All

Question 161

Question 2.10 Based on your other knowledge, the p value represents: (2 marks)

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The largest significance level at which the null hypothesis can be rejected

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The largest significance level at which the null hypothesis cannot be rejected

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The probability that errors have been made in rejecting or not rejecting the null hypothesis

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The smallest significance level at which the null hypothesis can be rejected

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The smallest significance level at which the null hypothesis cannot be rejected

Answer 161

The smallest significance level at which the null hypothesis can be rejected

Question 162

Question 2.11 Based on the adjoining table, the abstract and your other knowledge, choose the most accurate statement: (2 marks)

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Age and sex have not been adjusted for in this table

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A p value of 0.0898 is statistically significant

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FTND and HONC while not displayed are likely to be higher in slow metabolisers

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Higher levels were found for total daily puffs in normal metabolisers

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Higher NMR was significantly associated with total daily puffs

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Lower NMR was significantly associated with total daily puff volume

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Normal metabolisers had significantly lower mean levels of cigarettes per day

Answer 162

Higher NMR was significantly associated with total daily puffs

Question 163

Our findings seem to have internal consistency in that, while we showed an effect on CPD whereas several other studies have not, we also showed in our population an effect on topography and nicotine dependence.

Select ONLY ONE checkbox per page.

Question 2.12 Based on the adjoining excerpt and your other knowledge, in this study internal consistency means: (1 mark)

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Highly correlated items can be removed

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The Cronbach’s alpha is likely to be high

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The items all measured different things

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The items all measured the same thing

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The measures used were valid

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The study consistently used good measures

Answer 163

Crohnbach’s high

Question 164

Question 2.13 Based on the abstract, extracts and tables provided and your other knowledge, which of the following is not a likely limitation of the study: (2 marks)

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Measuring saliva not blood levels of nicotine metabolites

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Not all information was gathered on factors that would impact on blood nicotine levels – e.g. oral contraceptives

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Participants may have smoked cigarettes not using the device

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Smokers would not find a simple topography device easy to use

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The use of the topography device may alter smoking behaviours

Answer 164

Measuring saliva not blood levels of nicotine metabolites

Question 165

Question 2.14 Based on the abstract, extracts and tables provided and your other knowledge, which of the following statements is a conclusion of the study: (2 marks)

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Cigarette puffing in a clinical setting does not differ from a naturalistic enviroment

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Individual differences in nicotine metabolism are associated with smoke exposure

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Low metabolisers are more dependent on nicotine

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NMR is associated with tobacco use behaviours

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Smokers do not smoke more intensively when under observation

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The biological dose of tobacco exposure is attributed only to

the frequency of smoking

Answer 165

NMR is associated with tobacco use behaviours

Question 166

Each question is worth 1 mark

Amphetamine use

Anaemia of chronic disease

Cushing’s Disease

Epstein Barr virus

HIV

Huntington’s Disease

Hyperparathyroidism

Hyperthyroidism

Hypothyroidism

Interferon treatment

Lyme Disease

Prednisone use

Which of the above is the MOST likely to be demonstrated by each of the following examples?

Please select only ONE option, BUT ANY OPTION MAY BE USED MORE THAN ONCE, IF REQUIRED.

Jason, a university student aged 20, presents with low mood, fatigue and sore throat

Frannie, a 50 year old woman, presents with difficulty sleeping, anxiety and weight loss.

Gary, A 67 year old smoker with recent admission for exacerbation of COPD, presents with irritability, decreased sleep and overactive thinking.

Kim, a 45 year old ex-intravenous drug user, presents with abnormal liver function tests, low mood and symptoms of depression. Increased irritability is also reported.

Natasha, a 30 year old woman, presents with low mood and functional changes of depression. There is a family history of her father and paternal grandmother presenting with abnormal movements before dying early.

Answer 166

Epstein Barr Virus

Hyperthyroidism

Prednisone

HIV

Huntington’s