SPMM mocks Flashcards
A 65-year-old man has presented to the clinic with frontal lobe deficits
Identify two clinical features commonly seen in Medial prefrontal syndrome
Paucity of spontaneous behaviour and Poverty of speech
Also called apathetic, or pseudo depressive type is featured by a paucity of spontaneous behaviours, sparse verbal output, reduced social knowledge and judgement of harmful intent.
A 65-year-old man has presented to the clinic with frontal lobe deficits
Identify two clinical features commonly seen in Orbitofrontal syndrome
Poor impulse control and Explosive outbursts
also called disinhibited or pseudopsychopathic type and is characterised by poor impulse control, explosive outbursts, and inappropriate behaviour.
A 65-year-old man has presented to the clinic with frontal lobe deficits
Identify two clinical features commonly seen in Dorsolateral prefrontal syndrome
Executive dysfunction and Diminished planning
called as dysexecutive or disorganized type is featured by cognitive dysfunction, diminished judgment, planning and poor insight. The patients are also described to be concrete and inflexible in nature.
Identify the test which could be used in each of the following situation
Which of the above tests use the following question: ‘How many camels are there in England?’
Cognitive Estimation Test
In cognitive estimates test, factual questions that require abstract processing are asked. This is a test of frontal function.
Identify the test which could be used in each of the following situation
Scores are given for pronouncing the words DRACHM, SUPERFLUOUS and PLACEBO correctly
National Adult Reading Test
In NART, scores are given for correct pronunciation of complex phonetic words.
Identify the test which could be used in each of the following situation
The subject is asked to connect scattered numbers and alphabets in the sequence 1A2B3C4D5E6F…, using a pen and paper.
Trail Making Test B
In Trail Making Test A, the subject has to simply connect 1-2-3-4-5-6…etc as a sequence. In Trail Making Test B, the subject has to connect the sequence 1A2B3C4D5E6F…etc.
Match the following ECG changes with the most likely scenario
A 50-year-old woman has been feeling low in mood, and finding it difficult to sleep. She is prescribed a medication by her GP, which is increased over a period of 4 weeks. Subsequently she has an ECG after reporting palpitations and dizziness
Torsades de Pointes with use of antidepressant
At higher doses, antidepressants may cause Torsades de Pointes.
Match the following ECG changes with the most likely scenario
A severely depressed man is prescribed a medication, which leaves him with a dry mouth. A few days later he is found at home collapsed, having taken a significant overdose
QTc prolongation of >510ms
Amitriptyline is an antidepressant medication that causes dry mouth and QTc prolongation leading to severe ventricular arrhythmias, collapse and death
Match the following ECG changes with the most likely scenario
A middle-aged man admitted to the ward with chronic psychotic illness reports some chest discomfort. An ECG is performed
Saddle-shaped ST elevation
This is clozapine-induced pericarditis.
Match the following ECG changes with the most likely scenario
A young man with first episode psychosis is prescribed a medication and three months later has a routine ECG
Prolongation of QTc interval
Prolongation of QTc interval is a common side effect of antipsychotic medication.
Which eating disordered behaviour would be associated with description?
20-year-old woman with a history of bulimia nervosa. She stopped purging via self-induced vomiting 2 days ago and now describes painless swellings on her face.
Parotitis
Parotitis can be associated with bulimia nervosa, particularly after an individual ceases to purge. It is usually painless and resolves spontaneously. Medication to stimulate salivation may be useful.
Which eating disordered behaviour would be associated with description?
19-year woman with a history of anorexia nervosa complicated by laxative misuse. She has recently stopped using laxatives and is currently engaging more with the planned treatment. She informs her care co-ordinator that she has been experiencing abdominal swelling.
Decrease in intestinal motility
Long-term laxative misuse is associated with overstimulation of the colon leading to constipation once the laxatives are discontinued. Ideally, laxatives would be gradually withdrawn to allow the colon to return to a normal tone in a graded fashion.
Which eating disordered behaviour would be associated with description?
32-year-old woman presenting to the emergency department with severe abdominal pain and vomiting. She describes a sharp epigastric pain radiating to the back. She claims that this pain gets worse with eating. Her partner refuses to believe her as she has an ongoing history of eating disorder with purging behaviours
Pancreatitis
Sharp epigastric pain radiating to the back that gets exacerbated by eating is a feature of acute pancreatitis. The onset of acute pancreatitis in the absence of heavy alcohol use or biliary disorders should prompt an enquiry regarding eating disorders.
Which of the following neurological signs are associated with situation
70-year-old former electrician who has suffered a left hemisphere CVA. He has subsequently recovered his right arm and leg function completely. He has discovered that, although he has suffered no residual weakness or loss of sensation, he cannot not use his tools as usual. If told to do something he cannot carry out the action but can do so if he is not thinking consciously about it.
Ideomotor apraxia
This is ideational apraxia. Patients have an inability to conceptualise a task and impaired ability to complete multistep actions. They struggle to select and carry out an appropriate motor program. For example, the patient may complete actions in incorrect orders, such as buttering bread before putting it in the toaster, or putting on shoes before putting on socks.
Which of the following neurological signs are associated with situation
68-year-old woman who has suffered a CVA. She now finds it difficult to perform multi-stage actions, such as making a cup of tea, even though she can understand what to do and can repeat single actions if she is shown them by others.
Ideational apraxia
This is ideational apraxia. Patients have an inability to conceptualise a task and impaired ability to complete multistep actions. They struggle to select and carry out an appropriate motor program. For example, the patient may complete actions in incorrect orders, such as buttering bread before putting it in the toaster, or putting on shoes before putting on socks.
Which of the following neurological signs are associated with situation
58-year-old man who has suffered a significant head injury in a road traffic collision. He now finds that he cannot identify landmarks near his home, despite having been an avid local historian
Visuospatial agnosia
Visuospatial agnosia is a loss of the sense of “whereness” in the relation of oneself to one’s environment and in the relation of objects to each other
Identify the specific loci associated with the following disease
Parkinson’s Disease - Choose TWO options
SNCA gene located on chromosome 4, PRKN gene located on chromosome 6
Familial cases of Parkinson disease can be caused by mutations in the LRRK2, PARK7, PINK1, PRKN, or SNCA gene.
-The alpha-synuclein (SNCA) gene located in the long arm of chromosome 4
- The parkin (PRKN) gene located in the long arm of chromosome 6.
Identify the specific loci associated with the following disease
Fronto-temporal Dementia - Choose THREE options
C9ORF72 gene located on chromosome 9, MAPT gene located on chromosome 17, GRN gene located on chromosome 17
Most familial frontotemporal dementia is caused by mutations in three genes. These are a recently discovered gene called C9ORF72, and genes for the proteins tau (MAPT) and progranulin (GRN).
-C9ORF72 is located at 9p21.2, which is the short (p) arm of chromosome 9 at position 21.2 and is also associated with Amyotrophic Lateral Sclerosis.
-MAPT is located at 17q21.31, which is the long (q) arm of chromosome 17 at position 21.31 and is associated with frontotemporal dementia with Parkinson-17 and progressive supranuclear palsy.
- GRN is located at 17q21.31, which is the long (q) arm of chromosome 17 at position 21.31.
Identify the specific loci associated with the following disease
Huntington Disease - Choose ONE option
HTT gene located on chromosome 4
Mutations (CAG trinucleotide repeats) in the HTT gene cause Huntington disease. It is located at 4p16.3, which is the short (p) arm of chromosome 4 at position 16.3. The HTT gene provides instructions for making a protein called huntingtin.
Which of the brain parts are associated with the below scenarios?
37-year-old man with a history of alcohol dependence. His family have brought him into A&E after visiting him at home and finding that his memory appeared to be impaired. They reported that he kept forgetting that they were in his house.
Mamillary body alpha ketoglutarate
Korsakoff’s syndrome is due to thiamine deficiency, usually in the context of alcohol dependence. Thiamine is essential for the decarboxylation of pyruvate, and deficiency during this metabolic process is thought to cause damage to the medial thalamus and mammillary bodies of the posterior hypothalamus, as well as generalised cerebral atrophy
Which of the brain parts are associated with the below scenarios?
28-year-old woman with a diagnosis of depression who has been started on antidepressants. She wants to know about serotonin metabolism and asks about the main storage site for serotonin in the brain
Raphe nuclei
The neurons of the raphe nuclei are the principal source of serotonin release in the brain.
Which of the brain parts are associated with the below scenarios?
22-year-old woman presenting with a history of recurrent hypersomnia associated with symptoms of hyperphagia, hypersexuality, and cognitive impairment
Hypothalamus
Kleine-Levin syndrome is a recurrent hypersomnia associated with symptoms of hyperphagia, hypersexuality, and cognitive impairment. Kleine-Levin syndrome is rare, affecting an estimated 1-5 per million individuals. There are only approximately 200 reported cases to date in the literature. The symptoms of Kleine-Levin syndrome are characterized by their intermittent and periodic nature. During episodes, patients complain of excessive daytime sleepiness, despite sleeping anywhere from 12 to 21 hours per day. While awake, patients are often apathetic and report impairment in communication, concentration, and memory. The classic triad of hypersomnia, hyperphagia, and hypersexuality is not always present. In fact, in one large case series, only 45% of patients presented with all three symptoms. Hypersexuality is much more common in men than women. Thalamic hypoperfusion has been the most consistent finding in these studies when patients are examined during their symptomatic period. Once patients revert to their normal behavior, the thalamic hypoperfusion seems to resolve, while residual hypoperfusion persists in other brain locations. Fludeoxyglucose-positron emission tomography scanning has demonstrated asymmetric hypometabolism in the thalamus and hypothalamus.
Identify the age of the following developmental milestones
Ability to build a tower of 6 cubes
2 years
Identify the age of the following developmental milestones
Crawling
6-9 months
Identify the age of the following developmental milestones
Copying a square
4 years
Identify the age of the following developmental milestones
Ability to say “dada” and “mama” correctly
12 months
Identify the age of the following developmental milestones
Ability to use simple sentences
3 years
Regarding anti-dementia medication
What is Memantine’s mechanism of action?
Choose TWO options
Non-Competitive NMDA receptor antagonist, 5-HT3 receptor antagonist
Regarding anti-dementia medication
What is Galantamine’s mechanism of action?
Choose TWO options
Nicotinic receptor modulator, Selective and reversible acetylcholinesterase inhibitor
Regarding anti-dementia medication
What is Rivastigmine’s mechanism of action?
Choose TWO options
Pseudo-irreversible acetylcholinesterase inhibitor, Butyrylcholinesterase inhibitor
Regarding anti-dementia medication
What is Donepezil’s mechanism of action?
Choose ONE option
Selective and reversible acetylcholinesterase inhibitor
How do you make the following medication change
Amitryptiline to citalopram
Half dose, start new drug, then slow withdrawal
How do you make the following medication change
Fluoxetine to Tranylcypromine
Withdraw and wait for 5-6 weeks
How do you make the following medication change
Phenelzine to Sertraline
Withdraw and wait for 2 weeks
How do you make the following medication change
Fluoxetine to duloxetine
Stop and start other drug immediately
How do you make the following medication change
Trazodone to Mirtazapine
Cross taper with caution
Which one of the following is not a frontal lobe function test?
Tower of London, Verbal fluency, Luria’s motor tests, California Verbal Learning Test, Cognitive estimates
California Verbal Learning Test
Frontal lobe tests include Stroop test, Halstead trial making, cognitive estimates, Tower of London, Wisconsin card sorting test, verbal fluency, Luria’s motor tests and multiple errands tests. The California Verbal Learning Test (CVLT) is useful to assess verbal memory. Though it may be affected in patients with frontal lesions, CVLT is not a specific frontal lobe test.
Aura is a commonly occurring phenomenon seen in which type of seizures?
Complex partial seizures
In a Broca’s area lesion, which of the following features is seen?
Comprehension is preserved
Patients with Broca’s aphasia produce slow, halting speech that is rarely grammatical. Typical Broca’s aphasics eliminate inflections such as -ed and words not central to the meaning of the sentence, such as ‘the’ and ‘and’.
A 50-year-old woman began complaining of double vision and blurry vision 3 months ago and has since had diminishing interaction with her family, a paucity of thought and expression, and unsteadiness of gait. Her whole body appears to jump in the presence of a loud noise. An MRI scan and routine CSF examination are unremarkable. What is the most appropriate diagnosis?
Creutzfeldt-Jakob disease
The neurological complaints occurring early in the course of Creutzfeldt-Jakob disease are often cerebellar or visual. Patients may complain of ataxia, clumsiness, or dysarthria, as well as diplopia, distorted vision, blurred vision, field defects, changes in colour perception, and visual agnosia. Ultimately cortical blindness may occur.
5-year-old boy with poor social interactions and stereotypical behaviours. Which part of the brain would you expect to be dysfunctional?
Vermis of cerebellum
This boy has features of autistic spectrum disorder that includes poor social interactions, and stereotypical behaviours. Hypoplasia of cerebellar vermis (involving to some extent the cerebellar hemispheres) is well-documented in autism. Purkinje cell count in the cerebellum is significantly lower in patients with autism.
Which of the following structures are employed in processing emotionally salient memories?
Amygdala
The amygdala and hippocampal complex, two medial temporal lobe structures, are linked to two independent memory systems, each with unique characteristic functions. In emotional situations, these two systems interact in subtle but important ways. Specifically, the amygdala can modulate both the encoding and the storage of hippocampal- dependent memories. The hippocampal complex, by forming episodic representations of the emotional significance and interpretation of events, can influence the amygdala response when emotional stimuli are encountered.
A gentleman presents with a 1-day history of sudden onset symptoms of akinetic mutism. What is the vascular origin of this presentation?
Anterior cerebral artery
Bilateral infarct involving the anterior cerebral artery produces quadriparesis (legs weaker than arms) and akinetic mutism (ventromedial or cingulate syndrome).
Which of the following brain regions is associated with thermoregulation?
Pre-optic area
The pre-optic area is a region of the hypothalamus. It is responsible for thermoregulation. It receives nervous stimulation from receptors in the skin, mucous membranes and hypothalamus
67-year old man admitted to the geriatric ward with a history of recent weight loss. On obtaining further history, he admits to loss of the sense of smell. This feature is suggestive of pathology in which part of the brain?
Frontal lobe pathology
Anosmia is the inability to perceive odour or loss of the sense of smell. A permanent loss of smell may be caused either by a loss of olfactory receptor neurons in the nose or damage to the olfactory nerve or the brain areas that process smell, usually after head injury or due to tumors of the frontal lobe.
Which of the following is the precursor of serotonin?
5-hydroxydopamine
5-hydroxyindoleacetic acid
5-hydroxytryptophan
5-hydroxytryptamine
Anandamide
5-hydroxytryptophan
5-hydroxytryptamine is serotonin
The somatodendritic inhibition of 5-HT release is regulated by
5-HT1A receptors
The 5-HT1A receptor is found at both somatodendritic and post-synaptic sites. Somatodendritic 5-HT1A receptors in the dorsal and median raphe nuclei are autoreceptors regulating 5-HT neuronal firing. Post-synaptic 5-HT1A receptors are found in the hippocampus and periaqueductal grey matter where they regulate behaviours such as resilience, impulsivity and restraint of excessive response to stress. The 5-HT1A receptor may be an important target in the action of antidepressants.
A 70-year-old woman awakens with inability to walk and is found on the floor by her family. Her examination shows right face, arm, and leg weakness and numbness. What is the most likely cause of her gait problems?
Left hemisphere infarction
The presentation is suggestive of a cerebral infarct, most likely to be on the left side as the woman is presenting with right-sided weakness.
77-year-old gentleman suffering from gradually progressive cognitive decline for last 6 months. He has history of Parkinson’s disease for last 3 years and suffers from visual hallucinations. The chemical that is mainly involved and deficient in this condition is
Acetylcholine
The diagnosis is Parkinson’s disease dementia. In both Lewy body dementia and Parkinson’s disease dementia, brain acetylcholine levels are reduced similar to Alzheimer’s disease. Therefore acetylcholinesterases (Anti-dementia drugs) could be used in the treatment of Lewy body dementia.
A patient was diagnosed with HIV almost 2 years ago. He is now presenting with cognitive impairment. Which of the following cells is least likely to be affected?
Neurones
Theoretically all the main cell types of the CNS, astrocytes, oligodendrocytes, neurons, perivascular macrophage and microglia, can be infected by HIV-1 since they possess the receptors and/or co-receptors for HIV-1 entry, but only the latter two are the most commonly infected cells by HIV-1.
Most studies have indicated an absence of in vivo infection in neurons. It is unclear whether detection of infected neurons is complicated by the loss of the infected neuronal populations.
Regional cerebral blood flow is affected in schizophrenia. Which of the following area is most likely to be affected?
Prefontal cortex
Hypofrontality has been repeatedly demonstrated.
In schizophrenia:
Hypoperfusion: frontal lobes and frontal cortex, anterior and medial cingulate gyri, and parietal lobes. Hyperperfusion: cerebellum, brainstem and thalamus.
The post-mortem examination done on an elderly gentleman who suffered from a slowly progressive non-amnesic cognitive impairment, disinhibition and pill-rolling tremors reveals ubiquitin inclusions. Which gene is most likely to reveal a mutation?
Progranulin
This is a case of frontotemporal dementia (FTD). FTD is caused by mutations in progranulin (PGRN) especially in familial FTD. PGRN is located on chromosome 17q21.31.
The density of D2 receptors seen in children before 5 years of age is greater than adult levels. Their regression to adult levels is reached during the second decade. The developmental process through which this is achieved is called
Pruning
Synaptic ‘pruning’ refers to the natural elimination of unnecessary synapses that normally occurs in adolescence, making the brain more organised and efficient.
A disturbance in cerebral torque is proposed as the underlying pathological change in which disorder?
Psychosis
‘Cerebral torque’ refers to opposing right-left asymmetries of frontal and parieto-occipital regions of the brain.
Crow’s hypothesis and observations suggest that a primary disturbance in psychosis is in brain structure, and this is related to cerebral asymmetry in the form of torque.
Which is the most common opportunistic infection of CNS in patients with AIDS?
Toxoplasma gondii
Toxoplasmic encephalitis (TE) is caused by the protozoan Toxoplasma gondii. The disease occurs almost exclusively because of reactivation of latent tissue cysts. Primary infection occasionally is associated with acute cerebral or disseminated disease. Seroprevalence varies substantially among different communities (e.g., approximately 15% the United States and 50%–75% in certain European countries). Prior to the introduction of antiretroviral drugs, the 12-month incidence of TE was approximately 33%. The incidence has decreased substantially with the initiation of ART. Clinical disease is rare among patients with CD4+ T lymphocyte counts more than 200 cells/μL. Primary infection occurs after eating undercooked meat containing tissue cysts or ingestion of oocysts that have been shed in cat feces and have sporulated in the environment (which requires at least 24 hours). No transmission of the organism occurs by person-to-person contact
Which of the following is a glucocorticoid receptor antagonist?
D-Cycloserine
Clozapine
Mifepristone
Agomelatine
Gabapentin
Mifepristone
Mifepristone is a glucocorticoid receptor antagonist. It is a blocker of type 2 glucocorticoid and progestin receptors, and the preliminary research findings suggest that it could effectively ameliorate symptoms of major depression.
The EEG findings of a patient shows multiple spike and wave activity. Identify the disease.
Myoclonic epilepsy
Common EEG findings include rapid spike wave and poly spike wave.
The substance that is secreted by hypothalamus and enhances food intake is
Neuropeptide Y
Food intake is regulated by various factors such as neuropeptide Y. Neuropeptide Y potently induces an increase in food intake, and simultaneously stimulates arginine- vasopressin (AVP) secretion in the brain
There is increased concentration in axon terminal prior to depolarisation with which ion?
Potassium
There is a negative resting membrane potential of around -70mV. It is maintained by the sodium pump, which actively transports sodium ions out of the cell and potassium ions into the cell. There is increased concentration of potassium ions in axon terminal prior to depolarization. An action potential is propagated by the depolarization spreading laterally to adjacent parts of the neurone. An action potential is initiated in the axon hillock when the synaptic signals received by the dendrites and soma are sufficient to raise the intracellular potential from -70 mV to the threshold potential of - 55mV. When this potential is reached, the Na+ channels present in the axon initial segment will open. This Na+ influx causes a rapid reversal of the membrane potential from -90 to +40 mV. When the membrane potential reaches +40mV, the Na+ channels close and the voltage-gated K+ channels open. K+ ions move out of the axon, and ‘repolarizes’ the membrane.
What is true regarding REM latency and depression?
Shortened REM latency is not a specific marker of depression
Shortened REM latency is not a specific marker of depression; similar changes have been reported in other psychiatric disorders including mania, schizophrenia, schizoaffective disorder, OCD, panic disorder, and eating disorders. Previously it was thought that REM latency may distinguish between certain subtypes of depression. It is now understood that patients with depression show characteristic sleep-EEG changes, including disinhibition of REM sleep characterised by shortened REM latency, or sleep- onset REM periods, prolonged first REM period, and enhanced REM density. Most antidepressants suppress REM sleep in patients and in healthy volunteers. REM suppression includes prolonged REM latency, reduced time spent in REM sleep, and decreased REM density. Withdrawal of REM suppressing antidepressants is followed by REM rebound (resulting in decreased REM latency, increased REM time, and enhanced REM density).
A patient attending your clinic, was started on clozapine a few weeks ago. He now complains of shortness of breath, tachycardia and fever. Which of the following would you request urgently?
Chest x-ray
CPK
Troponin
ECG
D-dimer
Troponin
The most important consideration is clozapine-induced myocarditis. It occurs within 6-8 weeks of starting clozapine (median 3 weeks). Symptoms include fever, tachycardia, flu-like symptoms, fatigue, dyspnea (with increased respiratory rate) and chest pain. One proposed monitoring protocol recommends obtaining baseline troponin I/T, C- reactive protein and echocardiography, and monitoring troponin and C-reactive protein on days 7, 14, 21 and 28. At least twice the upper limit of normal troponin was found in 90% of cases. In addition, persistent abnormally high heart rate or signs or symptoms consistent with infective illness should be followed by daily troponin and C-reactive protein investigation until features resolve.
Prolonged QTc interval is associated with:
Select one:
Diazepam
Buprenorphine
Methadone
Naltrexone
Naloxone
Methadone
Methadone alone or combined with other arrythmogenic agents may increase the likelihood of QT interval prolongation, which is associated with torsades de pointes and can be fatal. ECG monitoring is therefore recommended whilst taking methadone.
Your patient has a diagnosis of schizophrenia and is currently taking risperidone tablets. Her prolactin level tested recently shows an elevation that is twice the value recorded prior to commencing the treatment. Which of drug could be considered as the best possible add-on treatment?
Aripiprazole
For most patients with symptomatic hyperprolactinaemia, a switch to non-prolactin elevating drug is the first choice. An alternative with modest but evolving evidence is to add aripiprazole to existing treatment. Hyperprolactinaemia and related symptoms are reported to improve fairly promptly following the addition of aripiprazole.
A 47-year-old man developed seizures on taking an antipsychotic medication. The psychiatrist treating him initially reduced the dose of his antipsychotic, and later started him on sodium valproate. Which antipsychotic drug is most likely to produce this effect?
Clozapine
Seizures may occur at any time whilst taking clozapine. It is a dose and plasma level-related effect. Prophylactic valproate or lamotrigine is used in high-risk subjects when titrating to a high dose of clozapine. EEG abnormalities are common in those on clozapine treatment; these abnormalities do not always indicate seizure activity.
Patient with schizophrenia developed cardiomyopathy on taking this medication for the last 9 months. The most likely drug is
Clozapine
Clozapine is associated with myocarditis and cardiomyopathy. Myocarditis seems to occur within 6-8 weeks of starting clozapine (median 3 weeks) and cardiomyopathy may occur later in treatment (median 9 months) but both may occur at anytime.
Which one among the following is a risk factor for SSRI induced hyponatraemia?
High initial sodium
Low body mass
Male sex
Young age
Cold weather
Low body mass
Risk factors for SSRI induced hyponatraemia include old age, female sex, low body weight, low baseline sodium concentration, history of hyponatraemia, warm weather,
reduced renal function, medical co-morbidity and some drug treatments like carbamazepine, antipsychotics, thiazide diuretics, NSAIDs, cancer chemotherapy and drugs like tramadol, omeprazole and trimethoprim.
A patient has depression but would accept treatment only if the probability of drug induced weight gain is low. Which of the following antidepressants is best to avoid?
Duloxetine
Mirtazapine
Fluoxetine
Sertraline
Venlafaxine
Mirtazapine
Mirtazapine is associated with weight gain in around 1/5th of subjects, especially in the first 4 weeks of treatment. This effect may be secondary to its effects on the 5-HT2C and H1 receptors.
Which of the following is primarily tested by using Abnormal Involuntary Movement Scale (AIMS)?
Psychomotor agitation
Tardive dyskinesia
Jaw stiffness
Torticollis
Akathisia
Tardive dyskinesia
The AIMS records the occurrence of tardive dyskinesia (TD) in patients receiving neuroleptic medications. This test is used to detect TD and to follow the severity of a patient’s TD over time.
Which one of the following is the least likely feature associated with Neuroleptic Malignant Syndrome?
Persistent bradycardia
Hyperthermia
Muscle rigidity
Raised CPK levels
Autonomic lability
Persistent bradycardia
Bradycardia is not a feature seen in patients with NMS. The symptoms and signs of NMS include hyperthermia, rigidity, agitation, altered levels of consciousness, tachycardia, tachypnoea, hypertension, tremor, diaphoresis, raised CPK levels, leukocytosis and metabolic acidosis.
The upper normal value of QTc in females is
470 msec
The upper normal value of QTc in males is 440 msec and females is 470 msec. Mounting evidence links QTc values over 500 msec to a clearly increased risk of arrhythmia.
Which of the following mood stabilisers is most associated with the development of orofacial clefts when used during pregnancy?
Valproate
Valproate is the most teratogenic mood stabiliser. Valproate confers a higher risk (around 10% for major malformations) than carbamazepine and should not be used in women of child-bearing age except where all other treatment has failed. The most common congenital malformations with valproate are neural tube defects, cardiac anomalies, urogenital malformations (including hypospadias), skeletal malformations, and orofacial clefts. Major malformations, specifically orofacial clefts, have been reported with topiramate, though the risk of oral clefts may be higher in women with epilepsy who use higher doses. There is growing evidence that lamotrigine is safer in pregnancy than carbamazepine or valproate across a range of outcomes. The risk of major malformations with lamotrigine appears to be in the range reported for children not exposed to anticonvulsants.
Which class of psychotropics, when used during pregnancy, most increases the risk of orofacial clefts in newborns?
Mood stabilisers
Mood stabilizers (including valproate, carbamazepine, and topiramate), when used during pregnancy have been most associated with orofacial clefts in newborns. First trimester exposure to benzodiazepines were previously associated with an increased risk of oral clefts in newborns, but subsequent studies have failed to confirm this association.
Which of the following adverse effects has not been reported in association with therapeutic doses of SSRIs?
Photosensitivity
Hypertension
Hallucinations
Galactorrhea
Akathisia
Hypertension
Several published reports of SSRI-induced movement disorders are available; they mostly report akathisia, dyskinesia, parkinsonism and occasionally dystonia and bruxism. Most of these were reported when using normal therapeutic doses. SSRIs, especially escitalopram and paroxetine, are occasionally associated with galactorrhea. Though rare, photosensitivity and hallucinations have been anecdotally reported with SSRIs. Nevertheless, therapeutic range of SSRI dose is not associated with systemic hypertension, though SNRIs such as venlafaxine carries this risk especially above the dose of 225mg/day.
Which drug is likely to cause tricuspid valve displacement towards the apex of the right ventricle in the newborn, when used during pregnancy?
Lithium
Ebstein’s anomaly is a congenital heart defect in which the tricuspid valves are displaced towards the apex of the right ventricle. Lithium use has a well-known association with this cardiac malformation (relative risk is 10-20 times more than control). Some case reports have also implicated benzodiazepines, although this is rare.
The risk of developing seizures with the use of clozapine is increased by
0.1
Patients can have generalized tonic-clonic seizures during treatment with clozapine. Life-table analysis predicts a cumulative 10% risk of seizures after 3.8 years of treatment. Clozapine-related seizures appear to be dose-related. High-dose therapy (greater than or equal to 600 mg/day) was associated with a greater risk of seizures (4.4%) than medium (300 to 600 mg/day; 2.7%) or low doses (less than 300 mg/day: 1.0%). Also, rapid upward titration may increase seizure risk.
Which of the following antidementia drugs undergo breakdown by cholinesterase itself with no hepatic involvement in metabolism?
Rivastigmine
Donepezil
Galantamine
Memantine
Tacrine
Rivastigmine
Phenelzine has been shown to be superior to placebo in the treatment of
Social phobia
The monoamine oxidase inhibitors (MAOIs) have shown superior efficacy to other antidepressants in the the treatment of generalized social phobia. Phenelzine in particular, has extensive placebo-controlled trial evidence in support of its use in social anxiety with nearly 67% patients showing significant improvement during acute treatment.
Which one among the following statements about atypical antipsychotic drugs is incorrect?
Select one:
Atypical antipsychotic drugs have relatively high serotonin HT-2A to dopamine D-2 receptor binding ratios
The extrapyramidal safety of atypical antipsychotic drugs depends on the affinity for nigrostriatal dopamine D-2 receptors
Relatively high 5HT-2A to dopamine D-2 binding ratios of atypical antipsychotic drugs may be responsible for the efficacy and safety advantages.
Atypical antipsychotic drugs have less affinity for nigrostriatal than typical antipsychotic drugs
The efficacy of antipsychotic drugs appear to be determined by the affinity for nigrostriatal dopamine receptors
The efficacy of antipsychotic drugs appear to be determined by the affinity for nigrostriatal dopamine receptors
The efficacy of antipsychotic drugs appears to be determined by the affinity for mesolimbic dopamine receptors and not by the affinity for nigrostriatal receptors.
Which mood stabiliser is not recommended for prophylaxis of bipolar affective disorder?
Topiramate
There are no large trials indicating the usefulness of topiramate in BPAD. Current evidence is sparse and limited.
Which of the following is a prodrug whose metabolite is used as an individual compound therapeutically? Select one:
Citalopram
Zopiclone
Fluoxetine
Risperidone
Haloperidol
Risperidone
Paliperidone is 9-OH-risperidone.
Citalopram is not a prodrug - escitalopram is the therapeutically active S-enantiomer of citalopram.
Which antipsychotic has a longer therapeutic effect attributable to its active metabolite?
Select one:
Amisulpride
Risperidone
Chlorpromazine
Haloperidol
Sulpride
Risperidone
The apparent half-life of risperidone is 3 hours while the apparent half-life of 9-hydroxyrisperidone (also known as paliperidone) is about 21 hours (in extensive metabolizers). The pharmacokinetics of risperidone and 9-hydroxyrisperidone combined, after single and multiple doses, were similar in extensive and poor metabolizers, with an overall mean elimination half-life of about 20 hoursRisperidone
Which of the following measures can help reduce lithium-induced tremors? Select one: Drug holidays
Single large dose
Taking lithium after food
Smaller, more frequent doses
Change time of administration to mornings only
Smaller, more frequent doses
Administer the lithium in smaller, more frequent doses. Propranolol (30 to 160 mg/d) may also be helpful
A psychiatric trainee has started lamotrigine in addition to a second mood stabiliser for a lady with a relapse of bipolar affective disorder. The pharmacist is concerned that the second mood stabiliser will increase possibility of toxicity of the lamotrigine. The second mood stabiliser is most likely to be
Sodium valproate
Sodium valproate can inhibit the breakdown of lamotrigine and so can result in higher plasma levels of lamotrigine. Valproate also increases the risk of allergic rash seen with lamotrigine.
32-year-old man who has presented to his GP with symptoms of low mood, lack of enjoyment, poor sleep, low energy levels and diminished appetite. How long would he need to have these symptoms before he could be diagnosed with a depressive episode under ICD-10 criteria?
14 days
ICD-10 requires a person to have depressive symptoms most days, most of the time for at least 2 weeks before an episode of depression can be diagnosed.
35 year old who has recently been diagnosed with rapid cycling bipolar affective disorder. Which of the following is true about this disorder? Select one:
More common in males
Associated with stimulant use
Associated with hyperthyroidism
At least two episodes of bipolar disorder in 1 year
At least four episodes of bipolar disorder in 1 year
At least four episodes of bipolar disorder in 1 year
Rapid cycling bipolar affective disorder is defined as having 4 or more episodes of mood disturbance (manic, hypomanic, mixed or depressive) within 12 months.
The Sally Anne Test is a psychological test used with children. Which of the following is TRUE regarding the Sally Anne Test? Select one:
It is a test of second-order false belief tasks
It is a test of theory of mind
Girls are more likely to correctly interpret the test than boys
It is correctly interpreted by the age of 3
It was devised by Piaget
It is a test of theory of mind
The Sally Anne test is a test of theory of mind whereby children observe a scenario in which a doll (Anne) removes a marble from another doll’s (Sally’s) basket and places it in
a box. The other doll then enters the scene and the children are asked where it will look for its marble. To pass the children must identify that Sally will look in her basket as she does not know that the marble has been moved. Children generally pass it after the age of 4.
72-year-old woman who was admitted to the orthopaedic ward following a fall. On examination she appears confused, she’s ataxic and nystagmus is present. You read in her notes that she had a long history of alcohol dependence, and spent many years homeless. During her stay on the ward her confusion becomes less prominent but her cognitive impairment remains. Which of the following statements about Korsakoff is not true:
Select one:
Chronic and severe thiamine deficiency result in insufficient concentrations to enable thiamine to cross the blood-brain barrier
Once the features of Korsakoff have been recognised, they can be reversed using IV Thiamine
Reductions in thiamine-dependent enzymes lead to impairment of oxidative metabolism
Thiamine acts as a co-factor for alpha-ketoglutatare dehydrogenase
Reductions in thiamine pyrophosphate-dependent enzymes have been found in autopsied cerebellar vermis samples
Once the features of Korsakoff have been recognised, they can be reversed using IV Thiamine
Korsakoff is irreversible; it may be prevented with treatment in the preceding Wernicke’s encephalopathy with high dose parenteral thiamine.
40-year-old woman with a diagnosis of acute intermittent porphyria. Which of the following is FALSE about acute intermittent porphyria?
Select one:
It is an autosomal dominant disorder
Physical signs often include an abdominal rash
Psychiatric side effects often include psychosis
It is treated with haemin
It can be precipitated by use of clonazepam
Physical signs often include an abdominal rash
Acute Intermittent Porphyria is not typical characterised by a rash; abdominal pain is the most common symptom. It is usually inherited in an autosomal dominant manner but autosomal recessive inheritance has been described. It is caused by mutations in the HMBS gene, which codes for the enzyme porphobilinogen deaminase. It causes acute attacks of abdominal pain and other symptoms, potentially including psychosis. It can be precipitated by the use of medications, including clonazepam, alcohol, low carbohydrate diet, infections and hormone changes during the menstrual cycle. A high-carbohydrate (10% glucose) infusion is recommended, which may aid in recovery. Hematin and heme arginate is the treatment of choice during an acute attack. Heme is not a curative treatment, but can shorten attacks and reduce the intensity of an attack.
28 year old man who has been brought to A&E by his family as they have been concerned that he has been acting unusually at home and has been isolating himself. Whilst there he informs staff he describes experiencing autoscopic hallucinations. Which of the following is TRUE about this phenomenon?
It describes altered perception of colour
It is a normal clinical phenomenon
It is seeing oneself in one’s external space
It is seen only in depression
It is an outcome indicator
It is seeing oneself in one’s external space
An autoscopic hallucination is a visual misperception in which an individual sees himself or herself as if they are an external stimulus.
A patient had a traumatic brain injury following a collision between his car and another vehicle, two-and-a-half years ago. Following a period spent in a coma, he gradually recovered normal functioning in most domains. However, his partner feels his personality isn’t what it used to be. He doesn’t have the same humour or interests, he’s more predisposed to being emotional, sometimes angry. Which psychological test would you consider appropriate in testing for post- traumatic personality changes?
MMPI
The Minnesota Multiphasic Personality Inventory (MMPI) is a standardised psychometric test which has been used to test personality change and has some validity in cases of post-traumatic brain injury
Patient is attending the memory clinic and undergoing cognitive testing for suspected Alzheimer’s dementia. During one part of the examination the psychologist reads a list of 10 words. After 20 minutes and other tasks the patient is asked to recall as many words as possible. This is an example of testing
Delayed recall
Delayed recall involves the retrieval of previously encoded words, whereas delayed recognition measures only whether or not a word has been encoded and consolidated. Tests of free recall involve immediate assessment of what is recalled after a list is read e.g. upon hearing the list read, patients are instructed that they will be asked to repeat as many words as they can.
Asking the patient to point out whether a given word was in the original list after a delay is testing ‘delayed recognition’ as well as consolidation. Semantic memory refers to general world knowledge accumulated through the lifespan.
According to ICD-10, how long must symptoms be present for before a diagnosis of mania can be made?
7 days
ICD-10 states that manic symptoms must be present for at least 7 consecutive days for a manic episode to be diagnosed. Symptoms must be present for at least 4 days for an episode of hypomania to be diagnosed.
A mum is telling you about the challenges of looking after her three children, alongside managing her long-standing depression. The youngest is 18 months old. She’s noticed that when she leaves him on his own to play, he doesn’t seem bothered, unlike the other two who used to cry a great deal. When she has visitors to the flat, she finds that he plays alongside them quite calmly, even though he may not have met them before. When she returns to the room after a period of absence, he doesn’t seem to notice her much; he rarely makes eye contact. Taking into consideration the experiments conducted by Bowlby and Mary Ainsworth in studying attachment, which attachment style is mum describing?
Avoidant
Avoidant attachment is characterised by a desire to maintain emotional distance
25-year-old woman with an IQ of 36. How severe is her degree of learning disability?
Moderate learning disability
A classification of mild, moderate, severe and profound has been used to describe the degree of learning disability. IQ measurement has traditionally been used to define severity:
* Profound - IQ of less than 20
* Severe - IQ of 20-34
* Moderate - IQ of 35-49
* Mild - IQ of 50-70
Which of the following Personality Disorders is included in DSM-IV, but NOT ICD-10?
Select one:
Schizotypal Personality Disorder
Dependent Personality Disorder
Schizoid Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Schizotypal Personality Disorder
The World Health Organization’s ICD-10 uses the name schizotypal disorder. It is classified as a clinical disorder associated with schizophrenia, rather than a personality disorder as in DSM-5.
A man has asked for a consultation to discuss his concerns regarding his partner. He’s read about histrionic personality disorder, and wonders whether his partner’s struggles may be in keeping with this diagnosis. He describes her to you. Which of the following descriptions is not part of the criteria for a diagnosis of histrionic personality disorder?
Select one:
Her emotions tend to fluctuate rapidly, and others say that she can come across as quite shallow
She is easily influenced by others
She appears not to mind whether she is praised or criticised
At a party, she always talks loudly and has to be the centre of attention
She often wears revealing sexually provocative clothing
She appears not to mind whether she is praised or criticised
F60.4 Histrionic personality disorder
Personality disorder characterized by:
(a)self-dramatization, theatricality, exaggerated expression of emotions;
(b)suggestibility, easily influenced by others or by circumstances;
(c)shallow and labile affectivity;
(d)continual seeking for excitement and activities in which the patient is the centre of attention;
(e)inappropriate seductiveness in appearance or behaviour;
(f)over-concern with physical attractiveness.
Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.
Which of the following is true according to both the ICD-10 and DSM-IV descriptions of schizophrenia?
Select one:
Paranoid schizophrenia is not a feature
Residual schizophrenia is no longer a feature
Catatonic schizophrenia is not described
Undifferentiated schizophrenia is not described
Simple schizophrenia has been removed
Simple schizophrenia has been removed
Simple schizophrenia was not included amongst the schizophrenia subtypes in DSM-IV. In DSM-V, all schizophrenia subtypes have now been removed.
74-year-old woman, who was widowed seven years previously. She has been calling the police in order to report her neighbours, who she believes are transmitting cannabis from their flat into her water system, so that the water that emerges out of her taps smells of drugs. She believes they wish to pressure her to move out of her flat, so they can take it over and convert it into a drugs den. This is making Mrs Pozzini feel very anxious and agitated. She holds her beliefs absolutely. Which of the following criteria, according to the ICD-10, is necessary for a diagnosis of persistent delusional disorder?
Select one:
It must include a mood incongruent component
It cannot be diagnosed if the patient is living with someone else
The delusions must be present for at least one month
It can be diagnosed alongside paranoid schizophrenia
It is accompanied by a dementing illness
The delusions must be present for at least one month
All the others are not included in the ICD-10. The delusions are usually mood congruent. The diagnosis cannot be made alongside a diagnosis of paranoid schizophrenia or if accompanied by a dementing illness.
Latah is a culturally specific syndrome occurring amongst people from Southeast Asia. Under what is it classified in ICD-10?
Other neurotic disorder
Latah is classified under other specified neurotic disorders, along with many other culturally specific syndromes.
F48.8 Other specified neurotic disorders:
Includes:
Briquet’s disorder
Dhat syndrome
koro
latah
occupational neurosis, including writer’s cramp
psychasthenia
psychasthenic neurosis
psychogenic syncope
In the context of a loss event and subsequent grief, the term incentive salience refers to which of the following?
Select one:
Reality distortion in the presence of cues related to the dead person
Attentional bias towards the objects that belonged to the dead person
Cognitive bias towards the benefits of a death event
Lack of rewarding sensation from pleasurable activities
Reduced interest in items that remind us of the dead
Attentional bias towards the objects that belonged to the dead person
Why should a loss event make us feel sad universally? One explanation is offered through the model of incentive salience for grief (Freed and Mann, 2007). When an attachment figure dies (or leaves us), the rewarding feeling that we generally associate with the cues associated with them persists (e.g. photographs, the daily objects that they used etc.). These cues, given their associated incentive salience, automatically bias our attention towards them and trigger the unpleasant subjective yearning and sense of loss. This excessive attention toward an unavailable attachment figure serves to maintain grief’s core symptoms. Successfully reducing this elevated incentive salience during separation will help one to accept the loss. Sadness that emerges during grief reaction is an adaptive coping response, which serves to replace the association of rewarding, incentive salience with an unpleasant feeling that eventually serves to produce detachment.
37-year-old woman with a diagnosis of schizophrenia, who was admitted to the ward seven months previously. You are finding her speech to be unusual. Here’s an example of her communication: ‘when I went to the forest I was there by the herbal herbal bal bal balbalbal plot of land in that region, near the mountain tain tain tain tain….’. What word best describes her speech?
Logoclonia
In logoclonia there is meaningless repetition of the last syllables of a word or phrase.
43-year-old man with a long-standing history of schizophrenia. He attends clinic to see his psychiatrist. When the doctor offers to shake hands, he takes his hand 20 times but does not shake it. Which of the following best describes this phenomenon?
Ambitendency
Ambitendency is a phenomenon in which an individual alternates between resistance to and cooperation with instructions or prompts.
25-year-old man with a diagnosis of schizophrenia. He has experienced some voices and persecutory delusions but his main difficulties arise from the negative symptoms associated with his illness. Which of the following are negative symptoms of schizophrenia?
Waxy flexibility
Emotional insensitivity
Apathy
Diminished sleep
Elective mutism
Apathy
The negative symptoms of schizophrenia are: apathy, blunted or absent emotional responses, reduced speech, social withdrawal, diminished attention, anhedonia, sexual problems, lethargy.
Various forms of formal thought disorder have been described which each having distinct characteristics. Which of the following are characterised by a lack of causal links in the content of speech?
Select one:
Drivelling
Fusion
Metonymy
Asyndesis
Derailment
Asyndesis
Asyndesis describes a lack of genuine causal links in which clusters of more or less related sequences of thoughts, instead of well-knit sequences of thoughts are used, creating a feeling of vagueness.
Derailment is a form of thought disorder characterised by a sudden change in the train of thought and/or speech, either spontaneously or in response to an internal stimulus, from the topic’s track onto another which is obliquely related or entirely unrelated.
Metonymy involves approximate uses of words, such as paperskate rather than pen.
Fusion involves thoughts being fused together, leading to a loss of goal direction.
In drivelling there is a disordered intermixture of the constituent parts of one complex thought.
What best describes the sensation or concept of interoception?
Awareness of one’s physiological state
Interoception is defined as the sense of the internal state of the body. It encompasses the brain’s process of integrating signals relayed from the allowing for a nuanced representation of the physiological state of the body. This is important for maintaining homeostatic conditions in the body and potentially aiding in self-awareness. It is thought to be impaired in people with ASD.
45-year-old man who has been taken to the GP by his family, as they have been worried about him. He has been insisting that he worked at Buckingham Palace many years ago, despite having not done so and has telling people at work about it. What best describes this phenomenon?
Delusional memory
This is most likely to be a delusional memory. This is the symptom when the patient recalls as remembered an event or idea that is clearly delusional in nature. The delusion is retrojected in time. These are sometimes called retrospective delusions.
42-year-old woman who describes being able to recall daily events in great detail, “like watching a video”. What describes this form of memory?
Eidetic
This is most likely to represent eidetic memory, also called photographic memory. It is unclear if this is a real phenomenon.
Which type of formal thought disorder is characterised by two or more thoughts being interwoven into one?
Fusion
Fusion involves thoughts being fused together, leading to a loss of goal direction.
30-year-old woman who has a history of episodes of catatonic schizophrenia. She has recently been readmitted after experiencing a relapse with symptoms typical of her previous episodes of illness. Which of the following is a ICD-10 criteria for catatonic schizophrenia?
Select one:
Excitability
Mannerisms
Waxy flexibility
Reduced muscular tone
Mutism
Waxy flexibility
The criteria for catatonic schizophrenia are:
a. Stupor (marked decrease in reactivity to the environment and in spontaneous movements and activity) or mutism;
b. Excitement (apparently purposeless motor activity, not influenced by external stimuli);
c. Posturing (voluntary assumption and maintenance of inappropriate or bizarre postures);
d. Negativism (an apparently motiveless resistance to all instructions or attempts to be moved, or movement in the opposite direction);
e. Rigidity (maintenance of a rigid posture against efforts to be moved);
f. Waxy flexibility (maintenance of limbs and body in externally imposed positions);
g. Other symptoms such as command automatism (automatic compliance with instructions), and perseveration of words and phrases.
What is a method for teaching certain behaviours to children with intellectual disability in which each step gives a cue for the next action to be performed?
Chaining
Chaining involves breaking a complex behaviour into steps and then teaching one step at a time, adding a new one to those that have come before. The previous steps act as a prompt for the new one, thus building a chain.
Shaping involves giving positive reinforcement for approximations of a behaviour until it is mastering, e.g. congratulating a child for holding a fork when they hold it by the tines rather than the handle when teaching them to use cutlery.
Prompting involves reminding a child of what they need to be doing, however this is done.
In the context of memory retrieval, cueing is achieved via prompts or cues, which include anything that is connected in some way to target information in long-term memory, prompting retrieval of it.
Gestalt psychology describes 5 distinct principles of grouping. Which of the following is one of these principles?
Select one:
O Irritability
Proximity
Separation
Openness
The law of distinct fates
Proximity
The 5 principles of Gestalt psychology are: proximity, similarity, good continuation, closure, and the law of common fate. They were described to explain human perception of groups of objects and how we perceive parts of objects and form whole objects on the basis of these. The concept of proximity is sometimes referred to as the principle of distance.
Counter-conditioning is a psychological technique used in which psychotherapeutic intervention?
Systematic desensitisation
Counter-conditioning is a technique that is often employed as a part of systematic desensitisation when managing phobias and similar disorders. It involves the conditioning of an unwanted behaviour or response to a stimulus into a wanted behaviour or response by the association of positive actions with the stimulus. For example, when managing a phobia of dogs, a therapist may aim to associate an anxiety-provoking stimulus, such as a dog being in the next room, with a positive reward. Therefore, this will associate the positive reward with the stimulus and diminish the anxiety associated with the latter.
Wolpe, the proponent of systematic desensitization used Guthrie’s (1952) concept of counterconditioning to explain the long-term benefits of systematic desensitisation and claimed that desensitization replaced anxiety with relaxation.
A man and his family are preparing to travel for a family holiday. Sergio has struggled with phobias to particular situations for which he’s engaged in some behavioural therapy (relaxation training, exposure and response prevention) with a good outcome. His fear of snakes has subsided, but he discovers that other members of his family, even though they’ve not struggled with anxiety to the extent he has, also seem to have an aversive reaction to the sight of snakes. What theory can explain this phenomenon?
Stimulus preparedness
Stimulus preparedness implies that fear-relevant stimuli are biologically prepared, as opposed to only occurring in those who already fear snakes.
Which of the following best describes the Hawthorne Effect?
Select one:
Academic performance based on the expectation of others
Belief that an individual’s behaviour is representative of the behaviour of a group Tendency to perceive someone as wholly bad based on a small number of attributes
Not helping someone in need due to the presence of others
Temporary increase in work performance due to the presence of others
Temporary increase in work performance due to the presence of others
The Hawthorne effect describes the phenomenon of individuals or a group changing their behaviour in response to being observed. The bystander effect is a social psychological phenomenon in which individuals are less likely to offer help when other people are present.
The horn effect, closely related to the halo effect, is a form of cognitive bias that causes one’s perception of another to be unduly influenced by a single negative trait. The Pygmalion effect, or Rosenthal effect, is a psychological phenomenon wherein high expectations lead to improved performance in a given area. The targets of the expectations internalise their positive labels, and those with positive labels succeed accordingly; a similar process works in the opposite direction in the case of low expectations.
The group attribution error refers to people’s tendency to believe either (1) that the characteristics of an individual group member are reflective of the group as a whole, or (2) that a group’s decision outcome must reflect the preferences of individual group members, even when external information is available suggesting otherwise.
75-year-old man who has been subject to a cerebro-vascular event affecting his medial parietal lobe. You wish to test some of his cognitive capacities. You present him with a list of words and ask him to read them through. You then show him a second list and ask him to discern which of the words he sees are on both lists. What aspect of cognitive functioning are you testing?
Recognition
The scenario describes one of the simplest forms of testing for recognition, which makes the retrieval process easy to record and analyse.
Which of the following persists after ECT?
General confusion
Retrograde amnesia
Disorientation to place
Anterograde amnesia
Disorientation to time
Retrograde Amnesia
Retrograde amnesia, particularly for autobiographical memory is the most persistent complication after ECT. Confusion and disorientation usually resolves within 24-48 hours. Anterograde amnesia usually resolves within few weeks.
This type of aggression is often planned and may be used to attain a goal
Select one:
Positive aggression
Overt aggression
Hostile aggression
Instrumental aggression
Covert aggression
Instrumental aggression
Instrumental aggression is used with a specific goal in mind, such as obtaining money in the course of an armed robbery.
Hostile aggression is in response to a stimulus or provocation.
Aggression can be overt and easily identifiable, or covert and “passive-aggressive”, e.g. bullying.
Which of the following is true regarding self-serving bias?
Select one:
It is a type of attribution error
It attributes internal failures to internal sources
It occurs in depression
It is a form of self-compassion
It attributes external success to external sources
It is a type of attribution error
Some people attribute their successes to internal factors and their failures to external factors. It is called the self-serving bias, which helps to boost self-esteem.
The tendency for a group to make more risky decisions than individuals otherwise would make is known as
Risky shift
Risky shift describes the phenomenon whereby a group will make more risky decisions than an individual.
This is similar to group polarisation in which a group makes more extreme decisions than the individuals would, but in terms of their initial inclination, either cautious or risky.
17-year-old who recently sat her school exams. For the past three months, following the separation of her parents, she’s been feeling demotivated, finding it difficult to concentrate on her studies, feeling lethargic, sleeping more than usual. With her close friend Tamara, she goes to school to pick up their exam results. They both get a C as their final result. Tamara says that the reason she got a C is because their teacher was useless and didn’t explain the concepts required for the exam clearly enough; she’s sure that based on her own capacities, had she been properly coached, she would have achieved an A grade. Wynne on the other hand, isn’t surprised by her grade, and thinks that it’s her own incompetence that meant she didn’t get a higher grade. This scenario illustrates the concept of:
Self-serving bias
Self-serving bias is a type of cognitive bias in which positive events are attributed to one’s own character, and negative events to external factors. This can be reversed in depression.
Minority influence is a form of social influence whereby an individual or minority group persuades the majority to accept their beliefs or behaviour. Which of the following increases minority influence?
Select one:
Not being flexible
Emphasising their difference from the majority
Being consistent
Hostility to majority figureheads
Disregarding the majority view
Being consistent
Minority influence is increased by consistency in messaging, flexibility, appealing to the majority view and persuading majority figureheads to help propagate their views. If the minority is seen as being more similar to the majority, it also increases their influence.
When there is a discrepancy between co-existing but contradictory beliefs or attitudes, which of the following is an individual most likely to do?
Select one:
Seek information about the dissonant belief
Change one of their beliefs or attitudes
Discuss their difficulty with others
Weigh the available information objectively
Emphasise the importance of the contrast
Change one of their beliefs or attitudes
Individuals experiencing cognitive dissonance can resolve this by:
* Changing behaviours
* Changing beliefs or attitudes to reduce the dissonance
* Reduce the importance of the dissonance
* Ignore information that emphasises the dissonance
Of these, changing behaviours is the least likely to occur. Individuals do not tend to acknowledge the dissonance explicitly as this would involve recognising that their thoughts
are contradictory, which is psychologically threatening. They are most likely to change their beliefs or attitudes to reduce the dissonance.
There is evidence from sociopsychological studies that when individuals believe that someone else can respond to a situation, they are less likely to respond. What describes this phenomenon?
Diffusion of responsibility
Diffusion of responsibility describes the phenomenon of a person being less likely to take responsibility for action or inaction when others are present. It is considered a form of attribution as the individual assumes that others either are responsible for taking action or have already done so.
Asch’s studies of group dynamics focused around conformity and integration. According to his theories, which of the following would lead to disintegration of a group?
Select one:
Difficult work
Larger group size
Younger age
More public interactions
Equality between members
Equality between members
Asch theorised that group conformity was more likely with larger numbers, more challenging tasks, conversations being more public and individuals perceiving other members as being more senior than them.
Social pressure within groups can have a significant impact on the attitudes and behaviours of an individual. Which of the following would increase the likelihood of an individual expressing ambivalence?
Select one:
Feels less identified with group
The presence of a charismatic leader
There is a high degree of agreement in the group
Need to appear as part of the group
Need to promote harmony within the group
Feels less identified with a group
A lesser degree of identification with a given group increases the likelihood an individual will express ambivalence or a dissenting opinion.
12-year-old girl who is increasingly influenced by her peers and generally tries to act in a way that others will approve of. According to Kohlberg’s theory of moral development, which stage is she going through?
Interpersonal accord and conformity
She is likely in the conventional stage of interpersonal accord and conformity, or the good boy/girl orientation whereby individuals conform to social standards and are receptive to approval or disapproval from others as it reflects society’s views. They try to be a “good boy” or “good girl” to live up to these expectations having learned that being regarded as good benefits the self.
Which of the following is true about ethnic differences in access to mental health services in the UK?
Select one:
Most ethnic minorities that receive mental health care do so via their general practitioners Among the different ethnic groups, anxiety and depression are highest among white women Cultural competence of the providers does not affect access to care
Black and South Asian individuals are less likely to obtain mental healthcare
Psychotic disorders are less often diagnosed among black men
Black and South Asian individuals are less likely to obtain mental healthcare
Among BME communities, mental illnesses are more prevalent but less treated.
There is relatively higher prevalence of anxiety and depression in South Asian women (63.5% compared with 28.5% of white women), and psychotic disorders in Afro- Caribbean men (3.1% compared with 0.2% of white men).
In general, people from ethnic minorities are less likely than their White British counterparts to have contacted their GP about mental health issues in the last year, to be prescribed antidepressants, or to be referred to specialist mental health services. There is some evidence that hard-to-reach groups, including BME, are less likely to obtain appropriate mental healthcare and may be disadvantaged either because they are unable to access services or because they receive inadequate help from services. Factors considered important barriers to accessing services include cultural competence (i.e. the ability of providers and organisations to effectively deliver healthcare services that meet the social, cultural and linguistic needs of patients); cultural models of illness; stigma; fear and perceived discrimination and barriers to communication.
35-year-old Senegalese man who is brought to A&E by his family after becoming suddenly aggressive to his wife. He accused her of being a witch and tried to exorcise demons from her. He claimed to have seen the demons and became agitated and distressed. Which culture-bound syndrome best fits this description?
Bouffée délirante
Bouffée délirante describes sudden attacks of brief duration with paranoid delusions and often concomitant hallucinations, typically precipitated by an intense fear of magical persecution through sorcery or witchcraft. It is a syndrome occurring in Francophone West Africa and Haiti.
Which term is used to describe social disadvantage as a result of disability?
Handicap
Which of the following is FALSE about the concept of high expressed emotion?
Select one:
Patients with schizophrenia whose families have high expressed emotion are at an increased risk of relapse
In patients with schizophrenia whose families have high expressed emotion, males have a higher risk of relapse than females
The domains of critical comments, emotional over-involvement and hostility were most predictive of relapse
The proportion of high expressed emotion in carers of patients with schizophrenia is over 50%
Expressed emotions are measured using the Camberwell Family Interview
In patients with schizophrenia whose families have high expressed emotion, males have a higher risk of relapse than females
There is no evidence for a difference in the rate of relapse for men and women with schizophrenia exposed to high expressed emotion.
33-year-old Kashmiri man who works in an office in London. He speaks fluent English and often goes to the pub with his colleagues after work. At home, he speaks fluent Kashmiri and attends mosque with his family. In terms of culture he can be said to be:
Integrated
Cultural integration is a form of cultural exchange in which one group assumes the beliefs, practices and rituals of another group without sacrificing the characteristics of its own culture.
Which of the following is not true about Kohlberg’s theory of moral development?
Select one:
The stages are not culturally neutral
Individuals cannot skip stages
Individuals in conventional stages compare their actions with views of society
Individuals can display features of more than one stage at a time
All adults reach the post-conventional stage
All adults reach the post-conventional stage
All adults do not reach the post-conventional stages of moral development. At the same time, people in different cultures seem to move through the sequence at different rates and to reach different end-points. Edwards et al., in 1980, reported that in the West, most urban middle-class adults reach stage 4 (conventional), with a small percentage using some stage 5 (post-conventional) reasoning. In the isolated villages and tribal communities of many countries, however, it is rare to find any adult beyond Stage 3.
20-year-old woman with a diagnosis of anorexia nervosa who has been referred for a psychological assessment. Which of the following defence mechanisms is she most likely to utilise?
Denial, projection
Denial, rationalization
Splitting, acting out
Projection, splitting
Fantasy, avoidance
Denial, rationalization
Denial, rationalisation and intellectualisation are commonly seen in patients with anorexia nervosa.
78-year-old man who has brought his wife to the GP because he is concerned about some paranoid ideas she has been having. He matter-of-factly tells the GP about why he thinks she is behaving like this, and where the ideas might have come from. The defence mechanism he is utilizing is:
Intellectualisation
Intellectualisation is a form of defence mechanism where an individual concentrates on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions.
Rationalisation is a defence mechanism where the individual devises reassuring or self-serving but incorrect explanations for his or her own or others’ thoughts, actions, or feelings.
Which of the following is NOT a Kleinian defence?
Select one:
Denial
Projective identification
Introjection
Isolation
Splitting
Isolation
Isolation is not a Kleinian defence. It is characterised as a mental process involving the creation of a gap between an unpleasant or threatening cognition, and other thoughts and feelings. By minimising associative connections with other thoughts, the threatening cognition is remembered less often and is less likely to affect self-esteem or the self- concept. The other defences listed are more primitive and were addressed more by Klein in her work with children.
Which of the following defences is known as the Primary Defence?
Select one:
Isolation
Repression
Denial
Splitting Suppression
Repression
Repression has been referred to the Primary Defence for the unconscious as it involves preventing thoughts or impulses becoming conscious.
Which of the following is a mature defence?
Select one:
Somatisation
Splitting
Intellectualisation
Suppression
Acting out
Suppression
Suppression is the conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality; making it possible later to access uncomfortable or distressing emotions whilst accepting them.
According to Freud’s dual instinct theory, which of instinct is the dominant instinct in human psychology?
Thanatos
Dual instinct theory looks at Eros and Thanatos as life and death instincts. Freud believed that Thanatos underlay and accompanied Eros and so could be seen as more primal.
15-year-old boy who has had an argument with his mother about mess in his room and later cleans it without being asked. Which defence is he most likely to be utilising?
Undoing
In undoing an individual tries to “undo” an unhealthy, destructive or otherwise threatening thought by acting out the reverse of the unacceptable. It involves symbolically nullifying an unacceptable or guilt provoking thought, idea, or feeling by confession or atonement.
Some animals demonstrate the phenomenon of perceiving the first moving object they see after birth as being their mother. What best describes this?
Imprinting
This describes filial imprinting that is often seen in birds. Newly hatched chicks will identify an object seen after birth as their mother and follow it persistently. This tends to occur within a certain critical time period shortly after hatching. More generally, imprinting is any kind of phase-sensitive learning (learning occurring at a particular age or a particular life stage) that is rapid and apparently independent of the consequences of behaviour.
Identify the obstructive technique that may hamper information sharing
“Do you take a proper break from work every six months and are you able to relax?”
Polythematic questions
Compound or polythematic questioning is adding two or more questions in a single statement. This interview technique confuses the patient and will lead to either a vag response or non-response.
Identify the obstructive technique that may hamper information sharing
“These voices, which you are describing, are not from your head. Am I right?”
Suggestive questions
In suggestive questions, the answers are contained in the question. It misleads both the patient and the doctor. The patient is left with little choice.
Identify the obstructive technique that may hamper information sharing
When the patient stated, ‘Over the last four weeks I have had trouble with my sleep’, the doctor replied ‘We are here to talk about your mood.’
Disapproval
Disapproval is expressing unhappiness with a topic that the patient wants to discuss; may lead to withdrawal and not revealing the important problem faced by the patient
Identify the obstructive technique that may hamper information sharing
“You wanted to see me as nothing had gone well for you. But you just mentioned that you have got a new job and entered into a new relationship.”
Setting traps
Setting traps is tricking the patient using his words. Often seen as doctor’s attempt to negate patient’s problems.
Electrolyte abnormality
What electrolyte abnormality could be expected in a 52-year-old woman under the oncologists for breast cancer complains of being excessively thirsty
Hypercalcaemia
Polydipsia is a common symptom of hypercalcaemia. Hypercalcaemia is relatively common in cancer (20-30% of cancer patients develop hypercalcaemia). The most common cancers associated with hypercalcaemia are breast and lung cancer, and multiple myeloma.
Electrolyte abnormality
What electrolyte abnormality could be expected in a 22-year-old man, was brought into A&E in a coma. His friend said that they had been at a rave where he thinks the patient may have taken something. He describes him as being very chatty and overfamiliar. He said that because he had a lot of alcohol before, his friends encouraged him to drink lots of water to sober up.
Hyponatraemia
He has likely taken MDMA which results in chatty and overfamiliar behaviour, and excessive thirst. He has developed hyponatreamia secondary to over- drinking water due to this excessive thirst. MDMA also causes syndrome of inappropriate antidiuretic hormone (SIADH) which contributes to hyponatremia.
Electrolyte abnormality
What electrolyte abnormality could be expected in a 19-year-old woman, is under her GP for low mood. In the past she suffered from bulimia and struggles with her weight. Her boyfriend broke up with her a few days ago. Her friend Jess brings her to A&E as Jess noticed Lena was a little confused. She also has a tremor and some numbness and is dizzy.
Metabolic alkalosis
Metabolic alkalosis is associated with excessive vomiting. In this case, it is likely that Lena has started to binge and purge following the breakdown of her relationship putting her at risk of developing metabolic alkalosis.
Movement disorders
What movement disorder that matches the description - A man who kicks his wife once as he falls asleep.
Sleep myoclonus/hypnic jerk
Sleep myoclonus/hypnic jerk is an involuntary twitch that occurs just as a person is beginning to fall asleep
Movement disorders
What movement disorder that matches the description - A man on psychotropic medication for a long time who sleeps badly, wakes with a stiff back in the morning and takes at least 10 minutes to get out of bed
Parkinsonism
Parkinsonism is associated with antipsychotic medication resulting in stiffness, bradykinesia and tremor
Movement disorders
What movement disorder that matches the description - A man who experiences slow writhing movements in peripheral limbs
Athetosis
Athetosis is slow involuntary writing movements of the limbs caused by degeneration of the basal ganglia, as seen in Huntington’s disease. It can also be secondary to stroke or trauma.
Personality disorder
If all the general criteria for a personality disorder were met, what personality disorder would the traits described be indicative of?
He is berated by some of his acquaintances for holding onto money very tightly. He claims he has to hold onto it for future catastrophies, and will never offer to pay for someone else’s drink. He is regarded as miserly and uptight.
Anankastic personality disorder
Anankastic personality disorder: Traits include a preoccupation with orderliness and control (including over money), at the expense of flexibility. Rules are very rigidly maintained.
Personality disorder
If all the general criteria for a personality disorder were met, what personality disorder would the traits described be indicative of?
She is often at the centre of any party, and cannot bear to be overlooked or ignored. She makes sure she’s the centre of attention by wearing provocative clothes, laughing loudly and talking copiously and vivaciously.
Histrionic personality disorder
Histrionic personality disorder: Traits include excessive attention-seeking emotions including inappropriately seductive behaviour.
Personality disorder
If all the general criteria for a personality disorder were met, what personality disorder would the traits described be indicative of?
He always seems to have several girlfriends, often at the same time. They find him attractive and seductive, and he impresses them with his stories of evading the law for his own profit. The relationships don’t last long and Mike doesn’t seem bothered when they come to an end
Antisocial personality disorder
Antisocial personality disorder: Traits include ease on forming relationships, but not keeping them, superficial charm, lack of remorse for criminal or law-breaking activity, disregard for the rights of others.
Personality disorder
If all the general criteria for a personality disorder were met, what personality disorder would the traits described be indicative of?
He demonstrates the self-perception of being unique and superior to his peers.
Narcissistic personality disorder
Narcissistic personality disorder can be recognised by elevated sense of importance and significance compared to others.
Personality disorder
If all the general criteria for a personality disorder were met, what personality disorder would the traits described be indicative of?
She is persistently unreliable at work and has poor control of her finances
Emotionally unstable personality disorder
Emotionally unstable personality disorder usually involves marked impulsivity and a desultory approach to life; this usually leads to difficulties with finances and at work.
Diagnosis of acute disturbances
What would be the most likely diagnosis?
74-year-old woman who has recently had an elective hip replacement. Whilst on the orthopaedic ward she develops confusion, dyspnoea and chest pain 3 days postoperatively.
Pulmonary embolism
Chest pain and dyspnoea would make a pulmonary embolus likely. Significant hypoxia could lead to confusion.
Diagnosis of acute disturbances
What would be the most likely diagnosis?
6-year-old girl whose parents take her to the GP after they and her teachers notice that she is exhibiting episodes of blank staring and unresponsiveness lasting 10 to 15 seconds, which Helen is unaware of
Absence seizures
Describes absence seizures (also known as petit mal seizures) with classic brief periods of unresponsiveness but without any movement abnormalities.
Diagnosis of acute disturbances
32-year-old woman with a diagnosis of bipolar affective disorder. She develops coarse tremor and ataxia after going for a run whilst staying at her holiday let in Spain during her summer holiday.
Lithium toxicity
Llikely lithium toxicity due to dehydration. The patient has exerted themselves in a warm environment and has experienced fluid loss as a result.
Anxiety disorders
What is the most likely diagnosis?
A young man attends a CAMHS clinic. He has recently changed schools due to experiencing several difficulties. He also refuses to go out with friends or parents because he finds it uncomfortable to eat in front of people
Social phobia
diagnosis of social phobia or social anxiety characterised by difficulties in a school or social environment.
Anxiety disorders
What is the most likely diagnosis?
22-year-old who has been experiencing a two-week history of low mood, nervousness, poor concentration and hopelessness following the breakdown of her relationship with her boyfriend three months ago.
Adjustment disorder
suffering from adjustment disorder, which occurs up to 3 months (usually within 1 month) after a stressor and does not persist for more than 6 months after the
stressor.
Anxiety disorders
What is the most likely diagnosis?
15-year-old who attends CAMHS clinic following a change in behaviour; her parents describe that she often blinks repeatedly or counts on her fingers. Lauren eventually confides that she repeatedly sees horrible images in her head
Obsessive-compulsive disorder
a diagnosis of obsessive-compulsive disorder describing obsessional intrusive thoughts and counting compulsions.
Gait disorders
What is the likely diagnosis for this scenario
56-year-old woman who has been experiencing difficulties in starting to walk although she has little difficulty with movements involving her arms. She has no tremors of note.
Normal pressure hydrocephalus
Difficulty in gait initiation is typical in normal pressure hydrocephalus. It can also occur in Parkinsonism but difficulty in initiating movements tends to occur similarly in upper and lower limbs.
Gait disorders
What is the likely diagnosis for this scenario
19-year-old man who has long-standing difficulties with mobility. He walks in a semi-crouched state and his lower legs tend to cross over each other as he walks
Cerebral palsy
A gait in which the legs cross over or scissor is typical of an upper motor neurone lesion, particularly in cerebral palsy.
Gait disorders
What is the likely diagnosis for this scenario
45-year-old man who has been experiencing a gradual deterioration in his ability to walk. His steps are chaotic and variable in length and impaired by uncontrolled movements of his limbs at points.
Huntington’s disease
A chaotic gait impaired by choreic movements is characteristic of Huntington’s disease.
Gait disorders
What is the likely diagnosis for this scenario
72-year-old woman who has long-standing difficulties with mobilising. She walks bent forward and sometimes takes numerous small steps, seemingly to catch up with her body’s momentum.
Parkinson’s disease
A festinate gait is characterised by rapid small steps done in an attempt to keep the centre of gravity in between the feet while the trunk is leaning forward involuntarily and is classical in Parkinson’s disease and similar disorders.
Gait disorders
What is the likely diagnosis for this scenario
68-year-old woman who presents to her GP with a sudden onset difficulty in walking that started 2 days ago. She seems to be uncertain in her gait and places her feet far apart when taking a stride. She cannot stand with her feet together.
Cerebellar dysfunction
This scenario describes a broad-based gait and symptoms suggestive of truncal ataxia, both of which are associated with cerebellar disease.
Receptor mechanisms
This refers to the amount of the drug needed to produce a particular effect compared to another standard drug with similar receptor profile
Potency
Potency of a drug with receptor binding action refers to the amount of the drug needed to produce a particular effect compared to another standard drug with similar receptor profile (‘vigor’).
Receptor mechanisms
This refers to the ability of the drug to bind to its appropriate receptor
Affinity
Affinity refers to the ability of the drug to bind to its appropriate receptor (‘affection’).
Receptor mechanisms
This refers to how well the drug produces the expected response
Efficacy
Efficacy refers to how well the drug produces the expected response i.e. the maximum clinical response produced by a drug (‘productivity’).
Class of Antipsychotics
Give an example of a phenothiazine compound
Chlorpromazine, prochlorperazine, promazine, thioridazine or fluphenazine
Class of Antipsychotics
Give an example of a butyrophenone compound
Haloperidol, droperidol or benperidol
Class of Antipsychotics
Give an example of a dibenzodiazepine compound
Clozapine
Class of Antipsychotics
Give an example of a dibenzothiazepine compound
Quetiapine
Mechanism of action
Which drug is a partial D2 agonist?
Aripiprazole
From a pharmacological perspective, aripiprazole is different from other antipsychotic agents, as it is the only approved antipsychotic that reduces dopaminergic neurotransmission through D2 partial agonism, not D2 antagonism.
Name a 5HT1A agonist?
Buspirone
Buspirone is a full agonist at presynaptic 5-HT1A receptors and a partial agonist post-synaptically.
Name a multimodal agent that acts on 5HT1A autoreceptor as well as the serotonin transporter?
Vortioxetine
Vortioxetine is a relatively new antidepressant that acts on the serotonin transporter (SERT) to reduce reuptake, in line with SSRIs. In addition, it also acts as an agonist of 5- HT1A on the presynaptic neuron, in line with pindolol and buspirone. This prevents the desensitization of this autoreceptor, and thus accelerates the antidepressant effects.
Name an antipsychotic which binds to D1 receptors and binds with high affinity to 5HT2A receptors?
Olanzapine
Olanzapine binds with high affinity to the following receptors: serotonin 5HT2A/2C, 5HT6, dopamine D1-4, histamine H1, and adrenergic a1 receptors.
Neurohistology
Each of the cell types in the central and peripheral nervous systems have particular characteristics. Which 2 cell types commonly use glutamate as a neurotransmitter?
Granular and Pyramidal cells
Numerous neurons utilise glutamate as a neurotransmitter, including granular and pyramidal cells. Glutamate is also shuttled via astrocytes, though these cells do not use glutamate as a neurotransmitter primarily.
Neurohistology
Each of the cell types in the central and peripheral nervous systems have particular characteristics. Which cell type transmits motor signal from the cortex to the spinal cord?
Pyramidal cells
Pyramidal cells, particularly Betz cells, are part of the corticospinal tracts that conveys motor signals from the motor cortex to the spinal cord.
Neurohistology
Each of the cell types in the central and peripheral nervous systems have particular characteristics. Which cell type lines the cerebral ventricles?
Ependymal cells
Ependymal cells line the cerebral ventricles.
Neuropharmacology
Medications used in psychiatric practice often cause side effects, either because of their effects on target receptors in different areas of the body or affinity to non-target receptors. Which receptor is associated with the below side-effects?
32-year-old woman taking amisulpride who attends clinic and informs you that her periods have stopped.
D2 receptor
Most antipsychotics block D2 receptors and have the potential to cause hyperprolactinaemia due to blockade in the pituitary. This is more frequent in patients taking amisulpride, risperidone, paliperidone or a first generation antipsychotic. Common consequences of this are infertility and osteoporosis in the long-term. Galactorrhoea is also possible in both men and women.
Neuropharmacology
Medications used in psychiatric practice often cause side effects, either because of their effects on target receptors in different areas of the body or affinity to non-target receptors. Which receptor is associated with the below side-effects?
52-year-old man who has started a new medication but describes episodes of dizziness in the mornings or when standing up
Alpha-1-adrenergic receptors
The scenario appears to describe episodes of postural hypotension which can be linked to antagonism of alpha-1-adrenergic receptors. TCAs, mirtazapine and some antipsychotics are associated with this effect.
Neuropharmacology
Medications used in psychiatric practice often cause side effects, either because of their effects on target receptors in different areas of the body or affinity to non-target receptors. Which receptor is associated with the below side-effects?
68-year-old man who has started taking an antidepressant he had many years ago. He attends his GP reporting difficulty-voiding urine.
Muscarinic receptors
Antimuscarinic effects, which are common side-effects of TCAs, can cause urinary retention, as well as dry mouth, blurred vision and a variety of other effects.
Neuropharmacology
Medications used in psychiatric practice often cause side effects, either because of their effects on target receptors in different areas of the body or affinity to non-target receptors. Which receptor is associated with the below side-effects?
45-year-old woman who has been on a medication for 6 weeks but is keen to change to an alternative as she finds she is sleeping excessively and finds it difficult to wake in the mornings.
Histamine receptors
Histamine antagonism, such as that caused by mirtazapine, can cause marked sedation, which some patients find undesirable. Promethiazine and quetiapine also have this effect.
Function of Neuroglial cells
Cells which provide myelination to central nervous system
Oligodendrocytes
Function of Neuroglial cells
Cells which provide myelination to peripheral nervous system
Schwann cells
Function of Neuroglial cells
Cells which transport glutamate to promote clearance from synapse
Astrocyte
Rapid removal of glutamate from the synaptic space is required for the survival of releasing neurons. Although glutamate transporters are expressed by all CNS cell types, astrocytes are the cell type primarily responsible for glutamate uptake.
Function of Neuroglial cells
Cells which line the ventricles of the brain and the central canal of spinal cord
Ependymal cells
Ependymal cells line the CSF filled ventricles in the brain and the central canal of spinal cord.
Memory
Match the description with the correct type of memory
Remembering how to eat breakfast.
Procedural memory
Procedural memory, or ‘knowing how’, is the unconscious memory of skills and how to do things. It is acquired through repetition and practice.
Memory
Match the description with the correct type of memory.
Remembering what you ate for breakfast.
Declarative memory
Declarative memory is memory of facts and events that can be consciously recalled (also known as explicit memory).
Memory
Match the description with the correct type of memory.
Remembering what breakfast is.
Semantic memory
Semantic memory is a structured record of meanings, concepts, facts, knowledge about the world; it’s to do with general factual knowledge that is shared with others, independent of personal experience.
Memory
Match the description with the correct type of memory.
Remembering after you have eaten breakfast that you need to pick up more cereal on your way home from work.
Prospective memory
Prospective memory refers to that which needs to be remembered in the future, and may be defined as ‘remembering to remember’; it can be either event-based or time- based, and is often triggered by a cue (e.g. finishing breakfast).
Memory
Match the description with the correct type of memory.
Remembering that after breakfast you took your bike out and cycled your usual route to work, and this felt tedious.
Episodic memory
Episodic memory refers to experiences and specific events in time in serial form, from which we can reconstruct the actual events that took place in our lives; it is the memory of autobiographical events, and has an emotional charge.
Which of the following defence mechanisms is most prominent in subjects with narcissism?
Select one:
Idealisation
Discrimination
Acting out
Anticipation
Projection
Projection
Projection is commonly seen in narcissism. It involves taking one’s own unacceptable qualities or feelings and ascribing them to other people. For example, a narcissist with a strong dislike for someone, might instead believe that the other person does not like him. Narcissistic defences include the following:
1. repression
2. denial
3. rationalisation
4. projection
Avoidance is a defence mechanism most commonly used in:
Select one:
OCD
Agoraphobia
Hypochondriasis
Somatoform disorder
Depression
Agoraphobia
Avoidance is a powerful cognitive and behavioural strategy that serves as a negative reinforcer to reduce anxiety associated with agoraphobia.
(Most questions on defence mechanism/cognitive styles are based on psychotherapeutic theoretical grounding; not on quantitative evidence regarding frequency and prevalence)
F40.0 Agoraphobia include fears not only of open spaces but also of related aspects such as the presence of crowds and the difficulty of immediate easy escape to a safe place (usually home). The term therefore refers to an interrelated and often overlapping cluster of phobias embracing fears of leaving home: fear of entering shops, crowds, and public places, or of travelling alone in trains, buses, or planes.
Which of the following is true regarding adult personality over time?
Select one:
Males become more introverted with age
Neuroticism increases with age in men
Females show a significant decline in psychoticism but not neuroticism with age
Extraversion increases with age in men
Males show a significant increase in psychoticism with age
Males become more introverted with age
Males and females both show a decrease in extraversion, neuroticism and psychoticism with ageing.
In Piaget’s model of cognitive development, in which of the following stages does ‘conservation’ appear?
Concrete operational stage
Lack of conservation, presence of centration, irreversibility, class inclusion, and transitive inference are all characteristics of preoperative thought. The preoperational stage lasts from around 2-7 years of age.
Most children learn the rules for conservation at concrete operational stage (age 7 onwards).
Children often go through a process of using an item or non-physical object as a buffer between fantasy and reality during periods of anxiety. What is this phenomenon?
Transitional object
Infants initially have a period of so-called subjective omnipotence as their desires are fulfilled seemingly automatically, despite the objective reality being different. Realising that they are separate to their mothers or other caregivers can be distressing for the infant as they are reliant on another for their needs. Through fantasizing about the object of its wishes the child will find comfort. A transitional object can be used in this process. Donald Winnicott described this phenomenon.
Winnicot observed that the transitional object may be any material object (often a blanket, piece of cloth or a soft toy) to which young children frequently develop intense, persistent attachments. This object would be manipulated, sucked, or stroked, and often became an indispensable aid for falling asleep.
Rapprochement refers to a development stage in Mahler’s separation-individuation theory, which occurs between the ages of
14-24 months
Rapprochement refers to a development stage in Mahler’s separation-individuation theory, which occurs between 14-24 months. The child uses the caregiver as a base for exploration and frequently returns to them for reassurance whilst exploring their environment.
In Margaret Mahler’s Separation-Individuation Theory, at what age is a child in the Object Constancy Subphase?
2 years - 5 years
In Margaret Mahler’s Separation-Individuation Theory successful completion of this phase marks the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated. In addition, a sense of individuality begins to develop. The degree of ambivalence in the internalized model implicates the formation of a healthy self-concept and self-confidence.
A woman has sons aged 14 and 19, who are proving to be strong-willed and determined young men. She perceives a difference between the behaviours and mindset of her 14-year-old compared with that of her 19-year-old. She wonders about the effect of puberty of their developing brains, and what sorts of changes occur in the brain, that distinguish adolescence from adulthood. Which of the following statements regarding brain changes from adolescence to adulthood is correct?
Decrease in grey matter and increase in white matter
Between adolescence and adulthood the brain undergoes synaptic pruning, resulting in a steady decline of grey matter.
Myelogenesis is active during childhood and adolescence, peaking in the third decade of life, then decreases.
You are preparing a lecture on personality disorder for medical students, and you come across studies involving newborn rhesus monkeys, used by Harlow in the 1950s and 1960s in order to illustrate and contribute to the development of which of the following psychological concepts?
Attachment
Harlow studied the mechanism by which newborn rhesus monkeys bond with their mothers, suggesting that attachment develops as a result of tactile comfort, and not just the provision of food.
Ainsworth constructed a strange situation experiment with X separation and X reunion episodes?
2 separation and 2 reunion episodes
Ainsworth constructed a strange situation experiment with 2 separation and 2 reunion episodes. It is a controlled observation carried out in a comfortable room equipped with toys. An infant is observed in the presence and absence of its mother and a stranger in the vicinity in seven different combinations.
According to the infant’s behaviour it is classified as type A, B or C.
A- Anxious avoidant
B-Secure
C- Anxious resistant
Gender identity in a normal child develops around
3-4 years of age
Gender identity refers to the unshakable self-conviction of being male or female that begins around 18 months and gets fixed by 24 to 30 months. By age 3, most children are able to label themselves as either a boy or a girl. Most children develop stable sense of gender identity by age 4.
At what age can a child copy a circle with crayon?
2-3 years
In terms of fine motor skills, a child can copy a straight line with a crayon. By 30 months (2.5 years), he or she tries to copy a circle and a plus sign.
The range of pubertal time period in a boy lasts for duration of:
2-3 years
Boys enter puberty at an average age of 11-12 (one year later than girls) but this may occur anytime.
One of the largest cohorts of the pubertal adolescents reported so far has estimated the duration of puberty in boys to be around 2.4 years; in girls about 1.9 years. In this study, duration was defined by the difference in ages at onset of a pubertal growth spurt (OGS) and peak height velocity (PHV). Depending on the method used, the duration of puberty varies between 2 to 3 years in both sexes, with boys having longer duration than girls consistently (refer to Tanner’s method and Gasser’s method for further discussion).
Which of the following is INCORRECT with regards to child development?
Select one:
A 2-year-old child can say more than 50 words
A 5-year-old child can tell time by quarter of an hour accuracy
A 12-month-old child can speak up to 3 words
A child starts babbling at 4 months of age
A 4-year-old child speaks with correct grammar
A 5-year-old child can tell time by quarter of an hour accuracy
Reception class children (ages 4-5) should be beginning to read the time to the hour.
Year 1 children (ages 5-6) should be able to read the time to the hour or the half hour on analogue clocks.
Year 2 children (ages 6-7) should be able to read the time to the hour, half hour or quarter hour on analogue clocks.
When children are hospitalised for physical health problems, a short period of separation from their primary care giver ensues. This temporary separation from their loved one can cause
Anaclitic depression
Spitz described this. When children are hospitalised for physical health problems, a short period of separation from primary caregiver ensues; this loss produces anaclitic (object loss) depression. It is thought to be counterproductive to a child’s development. But recovery can be very good if maternal deprivation is kept to a minimum i.e. less than three months. To some extent, surrogate mothering can help an infant experiencing anaclitic depression.
A 4-year-old child asks ‘When do clouds sleep, papa?’ Which of the following features is she exhibiting?
Animism
Animism refers to the attribution of life and consciousness to certain inanimate objects.
Mahler is associated with:
Select one:
Autistic phase
Conventional morality
Anal phase
Operational stage
Individuality vs. inferiority
Autistic phase
Margaret Mahler proposed a separation-individuation theory in which a normal autistic phase was described.
A psychology student is keen to know about the ICD-10 duration criteria for the diagnosis of mania. The episode should last at least
1 week
Both ICD-10 and DSM-4 specify the manic episode should last at least 1 week and the disturbance is sufficiently severe to impair social and occupational functioning.
The symptoms of adjustment disorder resolve within
6 months
Adjustment disorder requires a stressor and that the symptoms should resolve within 6 months of termination of the stressor or its consequences.
What is the most common psychiatric diagnosis among those presenting to emergency departments following self-harm?
Adjustment disorder
The most common psychiatric diagnosis among those presenting to emergency departments following self-harm is adjustment disorder.
Which of the following descriptions is suggestive of dissocial personality disorder?
Select one:
Evidence of childhood conduct disorder
Sensitive to criticisms
Emotionally aloof
Flattened affectivity
Unclear identity
Evidence of childhood conduct disorder
A callous lack of concern for others, irresponsibility, irritability, aggression, tendency to act outside social norms, a disregard for the feelings of others, inability to maintain enduring relationships, low threshold for violence, a tendency to blame others, evidence of childhood conduct disorder are the reported features of dissocial personality.
ICD-10 diagnostic criteria for dissocial personality disorder includes:
Select one:
Low frustration tolerance
Diagnosis of conduct disorder
Incapacity to form relationships
Accepting inappropriate blame
Persistent irritability
Low frustration tolerance
ICD-10 diagnostic criteria include:
* a callous lack of concern for the feelings of others
* an incapacity to maintain (not establish) enduring relationships
* an incapacity to experience guilt
* a persistent proneness to blame others
* disregard for social norms
* a very low frustration tolerance
Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis. Persistent irritability may be an associated feature.
A HIV carrier with ring-like lesions on MRI scan is most likely to have a diagnosis of
Toxoplasmosis
Cerebral toxoplasmosis commonly affects patients with advanced HIV immunodeficiency. Toxoplasmosis with CNS involvement in patients who are immunocompromised can be severe and debilitating, and the condition may be fatal. Magnetic Resonance Imaging (MRI) scan shows multiple ring-enhancing lesions with extensive surrounding oedema in supratentorial as well as the infratentorial region.
Which one of the following tests would be best used for testing executive function?
Select one:
Thematic Apperception Test
Minnesota Multiphasic Personality Inventory
Trail Making Tests
Brief Psychiatric Rating Scale
Halstead-Reitan Battery
Trail making tests
The Trail Making Test (TMT) has two parts and the times taken to complete each part are used to measure central executive functioning.
In Part A, the participant must draw a line to connect consecutive numbers, 1 to 25. This tests visual screening, processing speed, attention.
In Part B the participant connects numbers and letters in an alternating progressive sequence (i.e. connect A-1-B-2-C-3 and so on). This tests central executive processes of task-set inhibition, cognitive flexibility, and the ability to maintain a response set.
In order to measure central executive functioning, the difference in time taken to complete TMT-B and TMT-A (which has little executive input) is calculated.
A doctor, during a clinical interview, tells a patient, “I think I now have a good idea of your financial situation; perhaps we should talk about your family problems now”. Which technique is the doctor utilising?
Transition
Transition is an interview technique used when moving from one to another topic. It is a very useful interview skill and preferably must be done as smoothly as possible to keep the patient interested.
What is the most common finding in a newly diagnosed patient with Parkinson’s disease?
Unilateral resting tremor
Unilateral resting tremor is the most common presenting feature in Parkinson’s disease.
A patient is suspected to have temporal lobe damage resulting from a vascular lesion. Which visual sign may be elicited on perimetry?
Upper quadrantanopia
Temporal lesions produce upper quadrantanopia due to damage to optic radiation.
A patient breaks down and cries during interview. Which technique is useful at this stage?
Validation
Validation statements facilitate the continuation of a clinical interview by ‘normalising’ experiences e.g. ‘it is normal to cry at difficult times.’
A man has a diagnosis of chronic schizophrenia. He has polyuria, polydipsia and becomes acutely confused. On further investigation, his serum sodium levels are notably low. What do you suspect?
Water intoxication
Water intoxication occurs particularly in patients with chronic schizophrenia. The clinical presentation includes polyuria, polydipsia, hyponatraemia, confusion, seizures, cerebral and peripheral edema. Death can occur in extreme cases. The cause is generally unknown.
Which of the following is NOT a feature of late-onset schizophrenia?
Select one:
Family history of schizophrenia is infrequent when compared to early onset
Less pronounced formal thought disturbances
White matter hyperintensities on MRI brain
Fewer negative symptoms
Prominent hallucinations
White matter hyperintensities on MRI brain
Late-onset schizophrenia is characterised by:
* a predominance of females
* fewer negative symptoms
* infrequent formal thought disorder
* prominent hallucinations (notably visual)
Associations include:
* social isolation
* sensory impairment
* premorbid paranoid personality traits.
Family loading for schizophrenia is lower than for early-onset cases (Howard et al., 2000).
White matter hyperintensities are not associated with late-onset schizophrenia (Howard 1995; Rivkin 2000) though one contradictory study exists favouring higher frequency of WMH in late-onset schizophrenia
A 44-year-old man with schizophrenia has intense suspiciousness and persecutory delusions. He tells you that his neighbours want him to prepare a home-made explosive with detonators. Which of the following would be the best response at this point of interview?
Select one:
Perhaps we should ask your neighbours if this is true
Why do you think your neighbours want you to do that?
No, I don’t think this sort of thing could happen
If you prepare explosives, we may have to involve the police
It doesn’t sound like a good idea to prepare explosives
Why do you think your neighbours want you to do that?
The main purpose of the interview is to collect clinically useful information that will enable diagnostic process and facilitate management. It is important to maintain a good therapeutic relationship with the patient while pursuing the above goals. Enquiring ‘Why do you think your neighbours want you to do that?’ serves both these purposes.
Regarding ‘Quality Of Life-16’, which of the following is true:
Select one:
It is a self-administered scale
It is a structured interview
It is a semi-structured interview
The maximal score is 16
It cannot be used in patients with chronic illnesses
It is a self-administered scale
Flanagan’s QOLS originally had 15 items, but was expanded to include a 16th item (independence). It measures five conceptual domains of quality of life:
1. material and physical well-being
2. relationships with other people
3. social, community and civic activities
4. personal development and fulfilment
5. recreation
It is most often used in samples with chronic illnesses. The QOLS is usually self-administered. It can also be completed by interview format. The QOLS can be completed in about 5 minutes. Scores can range from 16 to 112.
A patient with schizophrenia often rocks back and forth. He is also observed to be thumping his head with his fist for no apparent reason. He is exhibiting which symptom?
Stereotypy
This patient is demonstrating stereotypy; a symptom characterised by repetitive, functionless motor behaviour.
Stereotypies, mannerisms, and verbigeration are often elicited in patients with catatonic schizophrenia.
Hemiballism - hyperkinetic movement disorder characterised by violent involuntary proximal limb movements on one side of the body, caused by damage to the subthalamic nucleus of the basal ganglia. Unrelated to schizophrenia.
Ambitendency - a motor symptom where a patient who has been given an instruction alternates between automatic obedience and negativism e.g. when asked to shake hands, the patient appears indecisive, repeatedly extending and withdrawing their hand.
Ambivalence - described by Bleuler as one of the four primary symptoms of schizophrenia and was defined as having positive and negative emotions at the same time. Patients exhibiting ambivalence often have an inability to decide on an action.
Mannerisms - repetitive, goal-directed movements (e.g. saluting).
A patient that you see in your hospital corridor is moving his closed fist round to the right and round to the left in a repetitive manner. He is exhibiting:
Stereotypy
Repetitive, non-goal-directed motor activity (e.g. finger-play, repeatedly touching, patting or rubbing self) is called stereotypy. It is an abnormality not inherent in act but in its frequency.
A man using mescaline ‘smelt the noise of the trumpet’. This condition is known as:
Synaesthesia
This is a classical example of synaesthesia described by Sims. The phenomenon of perceiving a stimulus of one modality in a different modality (may be single or multiple modalities) is called synaesthesia. E.g. tasting the music, hearing colours and smelling voices. It is not a hallucination as the perceived object has an appropriate stimulus. Reflex hallucinations are a hallucinatory form of synaesthesia. A stimulus in one modality produces a hallucination in another modality.
