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MRCPsych Part B > Practice Questions > Flashcards

Practice Questions Flashcards

1
Q

What can one use as an adjuvant to antipsychotics for negative sx of schizophrenia?

A

D-cycloserine
Glycine
Seligine

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2
Q

How many patients on SSRIs experience sexual dysfunction?

A

70%

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3
Q

What receptor causes sexual dysfunction from SSRIs?

A

5HT2C stimulation

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4
Q

How long does untreated depression last for?

A

6-13 months

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5
Q

How long does treated depression last for?

A

3 months

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6
Q

How long does treated mania last for?

A

4-5 weeks

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7
Q

Which class of antidepressants are more commonly associated with switch to bipolar?

A

TCAs

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8
Q

What is used to define response to treatment for OCD?

A

A fall of at least 35% in the pre-treatment YBOCS score. after 6-12 weeks of Rx

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9
Q

What type of insomnia is related to anxiety?

A

initial insomnia

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10
Q

What causes middle insomnia?

A

Medical illness
Pain
Depression

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11
Q

For which PD is the term ‘quasi-psychotic’ used in ICD 10?

A

Schizotypal

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12
Q

Rate of depressed patients who switch to mania/hypomania?

A

7-12%

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13
Q

How do antipsychotics affect QTc?

A

Blocking K+ channels

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14
Q

Difference in onset of schizophrenia between men and women?

A

Men develop schizophrenia 5-6 years earlier

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15
Q

The strongest predictor of mortality in a patient with anorexia nervosa?

A

Alcohol abuse

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16
Q

How many patients with schizophrenia experience recurrent episodes of illness and develop significant progressive impairment

A

35%

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17
Q

How many patients with schizophrenia experience a simple episode of acute schizophrenia and have no residual impairment?

A

22%

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18
Q

How many patients with schizophrenia experience recurrent episodes of illness and have no or slight residual impairment?

A

35%

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19
Q

How many patients with schizophrenia experience recurrent episodes of illness and develop significant non progressive impairment?

A

8%

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20
Q

How many middle aged women on Lithium develop hypothyroid?

A

20%

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21
Q

DSM 5 diagnostic criteria for NMS?

A

Exposure to dopamine antagonsit in the last 72 hours, along with severe muscle rigidity and elevated temperature as well as mental status alteration (reduced or fluctuating level of consciousness), CK elevation (at least 4 times upper limit of normal), sympathetic nervous system lability, defined as at least 2 of the following:(hypertension, >25% of baseline, blood pressure fluctuation of =20 mmHg diastolic or =25 mmHg systolic change within 24 hours, diaphoresis, urinary incontinence), hypermetabolism, defined as heart rate increase (=25% above baseline) and respiratory rate increase (=50% above baseline).

These features must be present along with a negative work-up for infectious, toxic, metabolic, and neurological causes.

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22
Q

Best scale to measure EPSEs?

A

Simpson-Angus scale

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23
Q

Which medication is indicated if a patient on antipsychotic develops relapse of mania?

A

Lithium or Valproate augmentation

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24
Q

Risk of suicide one year after DSH?

A

1%

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25
Q

The proportion of patients diagnosed with schizophrenia that experience recurrent relapse and continued disability?

A

75%

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26
Q

Which parasomnia is more common in women?

A

Nightmares

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27
Q

Which tremor increases on intentional movement?

A

Cerebellar

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28
Q

Where is neurasthenia found in ICD 10?

A

Neurotic, stress-related and somatoform disorders

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29
Q

Diagnostic criteria for neurasthenia in ICD 10

A

a. either, persistent and distressing feelings of exhaustion after minor mental effort or persistent and distressing feelings of fatigue after minor physical effort; b. accompanied by one or more of the following symptoms: muscular aches or pains; dizziness; tension headache; sleep disturbance; inability to relax; and irritability;
c. inability to recover through rest, relaxation or enjoyment;
d. duration exceeds 3 months;
e. Does not occur in the presence of organic mental disorders, affective disorders or panic or generalised anxiety disorder.

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30
Q

Name the subcortical dementias

A

Parkinson’s disease dementia,
Huntington’s disease,
HIV-associated dementia,
Binswanger’s disease
Wilson’s disease.

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31
Q

What characterises subcortical dementias?

A

Gross psychomotor slowing,
Abnormal movements,
Low mood,
Mild amnesia
Apathetic personality.

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32
Q

How does Modafinil work?

A

Activates neurons containing orexins

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33
Q

Prevalence of depression in those with heart disease?

A

20%

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34
Q

Best SSRIs for pathological crying?

A

Fluoxetine
Citalopram

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35
Q

What percentage of women with postpartum psychosis will go on to develop schizophrenia later in their lifetime?

A

16%

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36
Q

‘Baby blues’ are reported in what proportion of new mothers?

A

3 in 4

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37
Q

Which antidepressants should be avoided in Epilepsy?

A

Amitriptyline
Dothiepin
Clomipramine
Bupropion

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38
Q

The male: female ratio of hypothyroidism is

A

1:6

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39
Q

Risk factors of depression in Parkinsons?

A

Female
Younger onset
Right-sided lesions
Bradykinesia
Gait disturbance
Rapid progression of disease
Poor cognitive status and ADLs

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40
Q

Which medication has best evidence for use in HIV dementia?

A

Zidovudine

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41
Q

Prevalence of any MI in HIV patients?

A

38-73%

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42
Q

Which INF has a good link to depression?

A

INF-Alpha

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43
Q

In post-stroke depression, the antidepressant treatment should be continued for at least?

A

6 months

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44
Q

What is the mean duration of a major depressive episode that follows a stroke?

A

34 weeks

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45
Q

The frequency of depressive symptoms in epilepsy is

A

30-50%

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46
Q

Frequency of panic disorder in epilepsy?

A

20%

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47
Q

Frequency of psychosis in epilepsy?

A

3-7%

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48
Q

What is the lifetime prevalence of depressive symptoms in patients with multiple sclerosis?

A

40-50%

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49
Q

Best antidepressants for depression in MS?

A

SSRIs
Desimpramine

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50
Q

Risk of triggering relapse of MS with ECT?

A

20%

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51
Q

The gene for Huntington’s disease (HD) is located on which chromosome?

A

Short arm of chromosome 4

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52
Q

During pregnancy, where continued use of Valproate is deemed essential, what is the maximum dose recommended?

A

1000mg/day

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53
Q

When used as mood stabilizers, what is the minimum period suggested to withdraw anticonvulsant drugs?

A

1 month

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54
Q

What is the lifetime risk of suicide in Huntington’s disease?

A

10-15%

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55
Q

Neuropsychiatic features of Huntingtons

A

Subcortical Dementia
Gradual onset,
Early and significant impairment in executive function,

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56
Q

Which cognitive functions are preserved until late in Huntingtons?

A

Visuospatial
Semantic memory

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57
Q

Predominant cognitive impairment in Huntingtons?

A

Executive impairment

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58
Q

What is the chance of having a baby with congenital malformation if lithium is continued through the first trimester?

A

1 in 10

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59
Q

The rate of depression during pregnancy is

A

10%

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60
Q

Risk of relapse of depression in a pregnant woman who stops her medications?

A

5 times the risk

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61
Q

Risk of any birth defect from sodium valproate use in pregnancy?

A

7.2%

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62
Q

During what period of postpartum is there a risk of psychiatric disorders?

A

First 3 months

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63
Q

What is the relative risk of developing Ebstein’s anomaly for a child when the mother is on lithium throughout her pregnancy?

A

9.5

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64
Q

What percentage of new mothers develop postpartum depression?

A

10-15%

65
Q

What proportion of women with history of depression relapse when they discontinue antidepressants during pregnancy?

A

68%

66
Q

What proportion of women with history of depression relapse if they continue their medications in pregnancy?

A

26%

67
Q

What is the risk of developing spina bifida in the children of women treated with carbamazepine during pregnancy?

A

0.5-1%

68
Q

Which neurocognitive function is most affected in babies of mothers who took valproate during pregnancy?

A

Verbal IQ

69
Q

What is the proportion of individuals with epilepsy that commit suicide?

A

10%

70
Q

Suicide rate in schizophrenia?

A

6%

71
Q

Prevalence of DSH in psychosis?

A

25%

72
Q

How many patients with T1 Bipolar attempt suicide?

A

17%

73
Q

How many patients with T2 Bipolar attempt suicide?

A

24%

74
Q

How many patients with depression attempt suicide?

A

12%

75
Q

The proportion of those who progress from having mere suicidal ideas to plans or attempts within one year is

A

60%

76
Q

Best mood stabilisers for mixed affective disorder?

A

Lithium
Valproate

77
Q

1st line medication for depression in Bipolar

A

SSRIs

78
Q

What is Hopkins checklist?

A

symptom inventory, which measures symptoms of anxiety and depression (not psychosis). It consists of 25 items: Part I of the HSCL-25 has 10 items for anxiety symptoms; Part II has 15 items for depression symptoms.

79
Q

Which depot may have an antidepressant effect?

A

Flupenthixol

80
Q

Which depot can induce depressed mood?

A

Fluphenazine

81
Q

Which depot depots not require a test dose?

A

Risperidone

82
Q

Describe General Health Questionnaire

A

self-rated screening instrument for the presence of psychiatric illness

83
Q

Describe DIS

A

a non-clinician administered fully structured interview and used in Epidemiological catchment area study

84
Q

Minimum dose of Risperidone to be effective in first episode schizophrenia

A

1-2mg

85
Q

Minimum dose of Quetiapine to be effective in first episode schizophrenia

A

150mg

86
Q

Minimum dose of Amisulpride to be effective in first episode of schizophrenia

A

400mg

87
Q

Minimum dose of Chlorpromazine to be effective in first episode schizophrenia

A

200mg

88
Q

Which scale is used to monitor tardive dyskinesia?

A

AIMs

89
Q

Medication to use in depression & insomnia

A

Trazadone

90
Q

Antidepressants to use in depression & anxiety

A

Sertraline
Venlafaxine

91
Q

Which medication can cause hypospasdias in the fetus if used in pregnancy?

A

Valproate

92
Q

Which TCA is not safe in breastfeeding?

A

Doxepin

93
Q

Preferred SSRIs in breastfeeding?

A

Paroxetine
Sertraline
Fluoxetine

94
Q

Best antipsychotic with AF?

A

Aripiprazole

95
Q

Which antidepressants can provoke AF?

A

TCAs

96
Q

Which antipsychotics can provoke AF?

A

Clozapine
Olanzapine
Paliperidone

97
Q

Which antipsychotic is least likely to cause conduction problems?

A

Risperidone

98
Q

Antidepressants post-MI

A

Antidepressants are (usually) CI in first 2/12

99
Q

Which SSRIs to avoid in MI?

A

Fluvoxamine
Citalopram

100
Q

Which neuropsychiatric condition shows hypointensity of striatum?

A

Fahrs disease

101
Q

Which condition causes high stepping gait, paraesthesia of lower limbs and pupillary abnormalities?

A

Syphilis

102
Q

What sx are suggestive of stroke-related cognitive impairment?

A

Apraxia
Visuo-spatial neglect
Reduced attention

103
Q

Prevalence of post-CVE emotionalism?

A

15-35%

104
Q

Prevalence of pos-CVE apathy?

A

20%

105
Q

Which disorder is characterized by a peculiar gait of lurching with long strides and quick, involuntary knee flexion?

A

Neuroacanocytosis

106
Q

Which SSRI has been shown to be particularly effective in MS depression?

A

Sertraline

107
Q

% of preventable suicides in England according to MH teams?

A

22%

108
Q

% of suicides that occur within 3/12 of d/c?

A

25%

109
Q

The proportion of all episodes of self-harm that occur in people over the age of 65

A

5%

110
Q

The subsequent risk of suicide 10 or more years after an episode of self harm

A

3%

111
Q

The proportion of individuals who will harm themselves again in their lifetimes

A

40%

112
Q

Proportion of individuals who self harm that will repeat at least 5 times in a given year

A

10%

113
Q

Prevalence of DSH w/o suicide intent

A

2%

114
Q

Prevalence of suicidal attempts

A

4%

115
Q

Prevalence of suicide thoughts

A

15%

116
Q

Max dose of Escitalopram

A

10-20mg/day

117
Q

Max dose of Haloperidol

A

20mg/day

118
Q

Doses of Venlafaxine

A

75-375mg/day

119
Q

Doses of Duloxetine

A

60-120mg/day

120
Q

Doses of Fluvoxamine

A

100-300mg/day

121
Q

Doses of Paroxetine

A

20-50mg/day

122
Q

Dose of Amitriptyline

A

30-200mg/day

123
Q

Doses of Lofepramine

A

140-210mg/day

124
Q

Doses of Imipramine

A

10-200mg/day

125
Q

Doses of Dothepin

A

75-225mg/day

126
Q

Duration criteria for diagnosis of delusional disorder in ICD 10?

A

3/12

127
Q

Medications to use in treatment-resistant OCD?

A

Add antipsychotic to SSRI
Clomipramine
Clomipramine + Citalopram

128
Q

First line prophylactic agents for bipolar

A

Lithium
Valproate
Olanzapine

129
Q

Which type of OCD has high heritability?

A

Symmetry/ordering

130
Q

Which types of OCD respond poorly to SSRIs?

A

Hoarding
Sexual/religious thoughts

131
Q

Which types of OCD respond poorly to CBT?

A

Hoarding
Sexual/religious thoughts

132
Q

Which meds are used to reduce aggressive behaviour in PDs?

A

SSRIs

133
Q

Which meds are used to help with emotional dysregulation in PDs?

A

Anticonvulsants
Lithium

134
Q

Best antidepressant in hepatic impairment

A

Imipramine

135
Q

Best SSRIs for hepatic impairment

A

Paroxetine
Citalopram

136
Q

Best mood stabilisers in hepatic impairment

A

Lithium
Gabapentin

137
Q

Best antipsychotics in renal impairment

A

Olanzapine 5mg/day
Haloperidol 2-6mg/day

138
Q

SSRIs to use in renal impairment

A

Citalopram
Sertraline

139
Q

Antidepressants to avoid in severe renal impairment

A

Fluoxetine
Venlafaxine

140
Q

Antipsychotics with minimal pro-convulsive effects

A

Haloperidol
Trifluoperazine
Sulpride

141
Q

Most common CNS pathogen (opportunistic)?

A

Cerebral toxoplasmosis

142
Q

What causes Progressive multifocal encephalopathy?

A

PPV

143
Q

Which 2 antipsychotics have greatest risk of orthostatic hypotension?

A

Clozapine
Risperidone

144
Q

Which antipsychotic is least likely to cause tardive dyskinesia?

A

Clozapine

145
Q

Which therapy includes traps, dilemmas and snags?

A

CAT

146
Q

Prevalence of dysthmia?

A

4%

147
Q

M:F ratio of dysthmia?

A

1:2

148
Q

How many patients with vCJD have neurological sx prior to psychiatric?

A

15%

149
Q

How many patients with vCJD present with both neurological and psychiatric sx?

A

22%

150
Q

In old age, what percentage of patients that commit suicide have seen their GP on the same day of their suicide?

A

20%

151
Q

In old age, what percentage of patients that commit suicide have seen their GP within one week of their suicide?

A

40-50%

152
Q

In old age, what percentage of patients that commit suicide have seen their GP within one month of their suicide?

A

70%

153
Q

What does deletion of maternal segment of 15q11 lead to?

A

Prader-Willi

154
Q

How many patients charged with indecent exposure reoffend?

A

20-30%

155
Q

How many patients charged with indecent exposure have a history of sexual offences?

A

60%

156
Q

In which type of study is recall bias more common?

A

Case control

157
Q

The final stage within each cycle of the model described by Prochaska & DiClemente

A

Relapse

158
Q

How long does your driving license remain suspended if you have had an episode of mania?

A

3 months
6 months if 4 or more episodes in one year

159
Q

Poor predictors of first episode psychosis

A

Duration of untreated psychosis
Comorbid substance misuse
Insiduous mode of onset
Negative sx
Poor premorbid adjustment
Male gender
Non-adherence

MRCPsych Part B (64 decks)

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