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Question 1
Incorrect
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Sequence of events in formation of speech are:
Your Answer: Insula---Wernicke's area---arcuate fasciculus---broca’s area---motor cortex ---speech
Correct Answer: Wernicke’s area---arcuate fasciculus---broca’s area---insula---motor cortex---speech
Explanation:Wernicke’s area is located in the categorical hemisphere or left hemisphere in about 95% of right handed individuals and 60% of left handed individuals. It is involved in the comprehension or understanding of written and spoken language. In contrast Broca’s area is involved in production of language. Firstly, the language is accessed in the Wernicke’s area and these words are sent via the arcuate fasciculus to the Broca’s area, where instructions for articulation is generated. This is then sent from Broca’s are to the motor cortex for the articulation.
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This question is part of the following fields:
- Neuro-anatomy
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Question 2
Incorrect
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Which manual for diagnosing mental disorders popularized the use of operational criteria in psychiatric diagnosis?
Your Answer: DSM III-R
Correct Answer: DSM III
Explanation:The implementation of operational criteria in diagnosis was a significant feature of DSM III, which was a response to the criticism of the previous versions of the DSM that relied heavily on psychodynamic concepts. This shift in approach is often praised for revitalizing the field of psychiatry.
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This question is part of the following fields:
- Classification And Assessment
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Question 3
Incorrect
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What is the DSM-5's definition of 'gender dysphoria'?
Your Answer: To achieve a diagnosis there must be evidence of incongruence between the experienced and assigned gender prior to puberty
Correct Answer: To meet the diagnostic threshold the condition must be associated with significant distress
Explanation:The main requirement is a mismatch between an individual’s biological sex and their gender identity, which causes significant distress.
Gender identity is the person’s identification of lived role in society, which is separate from their biological sex. Gender can include non-binary and pangender identities, and cisgender refers to people whose gender is congruent with their biological sex. Gender identity is not the same as sexual preference, which is covered by separate diagnostic categories. The ICD-11 has redefined gender identity-related health, replacing diagnostic categories like “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood”, respectively. The DSM-5 uses the term ‘gender dysphoria’ to cover the whole range of gender identity disorders, which is characterized by a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, and associated with clinically significant distress of impairment in social, occupational, of other important areas of functioning.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 4
Correct
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What type of antidepressant is classified as specific for noradrenaline and serotonin?
Your Answer: Mirtazapine
Explanation:Antidepressants: Mechanism of Action
Antidepressants are a class of drugs used to treat depression and other mood disorders. The mechanism of action of antidepressants varies depending on the specific drug. Here are some examples:
Mirtazapine is a noradrenaline and serotonin specific antidepressant (NaSSa). It works by blocking certain receptors in the brain, including 5HT-1, 5HT-2, 5HT-3, and H1 receptors. It also acts as a presynaptic alpha 2 antagonist, which stimulates the release of noradrenaline and serotonin.
Venlafaxine and duloxetine are both serotonin and noradrenaline reuptake inhibitors (SNRIs). They work by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Reboxetine is a noradrenaline reuptake inhibitor (NRI). It works by blocking the reuptake of noradrenaline, which increases its availability in the brain.
Bupropion is a noradrenaline and dopamine reuptake inhibitor (NDRI). It works by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Trazodone is a weak serotonin reuptake inhibitor (SRI) and 5HT agonist. It works by increasing the availability of serotonin in the brain.
St John’s Wort is a natural supplement that has been used to treat depression. It has a weak monoamine oxidase inhibitor (MAOI) effect and a weak SNRI effect.
In summary, antidepressants work by increasing the availability of certain neurotransmitters in the brain, such as serotonin, noradrenaline, and dopamine. The specific mechanism of action varies depending on the drug.
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This question is part of the following fields:
- Psychopharmacology
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Question 5
Correct
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John is a 35-year-old businessman. He is seeking therapy for his anxiety and the therapist is struggling to understand his constant need for attention and validation. They are also confused by his rapid mood swings, going from feeling hopeless and defeated to being overly confident and grandiose. He often shows up to sessions in flashy clothing and talks about his accomplishments and successes. His wife mentions that he has always been this way and that his charisma was what initially attracted her to him.
What is the probable diagnosis?Your Answer: Histrionic personality disorder
Explanation:John’s behavior is causing distress and impairment in his ability to participate in family therapy and may have contributed to his child’s depression. His behavior is consistent with histrionic personality disorder, which is only found in the ICD-10. This disorder is characterized by self-dramatization, exaggerated emotions, suggestibility, a shallow and unstable emotional state, a constant need for attention and excitement, inappropriate seductive behavior, and an excessive concern with physical appearance. Other associated features may include egocentricity, self-indulgence, a constant desire for appreciation, easily hurt feelings, and manipulative behavior to meet personal needs.
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This question is part of the following fields:
- Diagnosis
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Question 6
Correct
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What is the term used to describe the ratio of individuals who possess a specific gene variant and exhibit the corresponding trait?
Your Answer: Penetrance
Explanation:Heterogeneity is characterized by the existence of multiple genetic abnormalities that result in the same disorder.
Understanding Penetrance in Genetic Diseases
Penetrance refers to the likelihood of individuals with a specific genetic mutation developing clinical symptoms of a disease. It is expressed as a percentage, indicating the proportion of individuals with the mutation who exhibit symptoms. For instance, if a mutation in a gene responsible for an autosomal dominant disorder has a penetrance of 90%, it means that 90% of individuals with the mutation will develop the disease, while the remaining 10% will not.
Penetrance is an essential concept in genetics, as it helps to predict the likelihood of a disease occurring in individuals with a specific genetic mutation. However, it is important to note that penetrance can vary depending on several factors, including age, gender, and environmental factors. Therefore, it is crucial to consider these factors when assessing the risk of developing a genetic disease. Understanding penetrance can also aid in genetic counseling and the development of personalized treatment plans for individuals with genetic mutations.
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This question is part of the following fields:
- Genetics
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Question 7
Incorrect
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What study method would be most suitable for a researcher tasked with comparing the cost-effectiveness of olanzapine and haloperidol in reducing symptom severity of schizophrenia, as measured by the Positive and Negative Syndrome Scale?
Your Answer: Cost-utility analysis
Correct Answer: Cost-effectiveness analysis
Explanation:The task assigned to the researcher is to conduct a cost-effectiveness analysis, which involves comparing two interventions based on their costs and their impact on a single clinical measure of effectiveness, specifically the reduction in symptom severity as measured by the PANSS.
Methods of Economic Evaluation
There are four main methods of economic evaluation: cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), cost-utility analysis (CUA), and cost-minimisation analysis (CMA). While all four methods capture costs, they differ in how they assess health effects.
Cost-effectiveness analysis (CEA) compares interventions by relating costs to a single clinical measure of effectiveness, such as symptom reduction of improvement in activities of daily living. The cost-effectiveness ratio is calculated as total cost divided by units of effectiveness. CEA is typically used when CBA cannot be performed due to the inability to monetise benefits.
Cost-benefit analysis (CBA) measures all costs and benefits of an intervention in monetary terms to establish which alternative has the greatest net benefit. CBA requires that all consequences of an intervention, such as life-years saved, treatment side-effects, symptom relief, disability, pain, and discomfort, are allocated a monetary value. CBA is rarely used in mental health service evaluation due to the difficulty in converting benefits from mental health programmes into monetary values.
Cost-utility analysis (CUA) is a special form of CEA in which health benefits/outcomes are measured in broader, more generic ways, enabling comparisons between treatments for different diseases and conditions. Multidimensional health outcomes are measured by a single preference- of utility-based index such as the Quality-Adjusted-Life-Years (QALY). QALYs are a composite measure of gains in life expectancy and health-related quality of life. CUA allows for comparisons across treatments for different conditions.
Cost-minimisation analysis (CMA) is an economic evaluation in which the consequences of competing interventions are the same, and only inputs, i.e. costs, are taken into consideration. The aim is to decide the least costly way of achieving the same outcome.
Costs in Economic Evaluation Studies
There are three main types of costs in economic evaluation studies: direct, indirect, and intangible. Direct costs are associated directly with the healthcare intervention, such as staff time, medical supplies, cost of travel for the patient, childcare costs for the patient, and costs falling on other social sectors such as domestic help from social services. Indirect costs are incurred by the reduced productivity of the patient, such as time off work, reduced work productivity, and time spent caring for the patient by relatives. Intangible costs are difficult to measure, such as pain of suffering on the part of the patient.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 8
Correct
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What is the characteristic feature of EEG in individuals with Huntington's disease?
Your Answer: Shows a flattened trace
Explanation:Huntington’s Disease: Genetics and Pathology
Huntington’s disease is a genetic disorder that follows an autosomal dominant pattern of inheritance. It is caused by a mutation in the Huntington gene, which is located on chromosome 4. The mutation involves an abnormal expansion of a trinucleotide repeat sequence (CAG), which leads to the production of a toxic protein that damages brain cells.
The severity of the disease and the age of onset are related to the number of CAG repeats. Normally, the CAG sequence is repeated less than 27 times, but in Huntington’s disease, it is repeated many more times. The disease shows anticipation, meaning that it tends to worsen with each successive generation.
The symptoms of Huntington’s disease typically begin in the third of fourth decade of life, but in rare cases, they can appear in childhood of adolescence. The most common symptoms include involuntary movements (chorea), cognitive decline, and psychiatric disturbances.
The pathological hallmark of Huntington’s disease is the gross bilateral atrophy of the head of the caudate and putamen, which are regions of the brain involved in movement control. The EEG of patients with Huntington’s disease shows a flattened trace, indicating a loss of brain activity.
Macroscopic pathological findings include frontal atrophy, marked atrophy of the caudate and putamen, and enlarged ventricles. Microscopic findings include neuronal loss and gliosis in the cortex, neuronal loss in the striatum, and the presence of inclusion bodies in the neurons of the cortex and striatum.
In conclusion, Huntington’s disease is a devastating genetic disorder that affects the brain and causes a range of motor, cognitive, and psychiatric symptoms. The disease is caused by a mutation in the Huntington gene, which leads to the production of a toxic protein that damages brain cells. The pathological changes in the brain include atrophy of the caudate and putamen, neuronal loss, and the presence of inclusion bodies.
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This question is part of the following fields:
- Genetics
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Question 9
Correct
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Antagonism of which receptor is most likely to cause orthostatic hypotension?
Your Answer: Alpha 1
Explanation:Blocking H1 receptors, which respond to histamine, can lead to sedation and weight gain. Cimetidine, an H2 antagonist, is commonly prescribed for peptic ulcer disease. Ondansetron, which blocks the 5HT3 receptor, is effective in reducing nausea.
Receptors and Side-Effects
Histamine H1 Blockade:
– Weight gain
– SedationAlpha 1 Blockade:
– Orthostatic hypotension
– Sedation
– Sexual dysfunction
– PriapismMuscarinic Central M1 Blockade:
– Agitation
– Delirium
– Memory impairment
– Confusion
– SeizuresMuscarinic Peripheral M1 Blockade:
– Dry mouth
– Ataxia
– Blurred vision
– Narrow angle glaucoma
– Constipation
– Urinary retention
– TachycardiaEach receptor has specific effects on the body, but they can also have side-effects. Histamine H1 blockade can cause weight gain and sedation. Alpha 1 blockade can lead to orthostatic hypotension, sedation, sexual dysfunction, and priapism. Muscarinic central M1 blockade can cause agitation, delirium, memory impairment, confusion, and seizures. Muscarinic peripheral M1 blockade can result in dry mouth, ataxia, blurred vision, narrow angle glaucoma, constipation, urinary retention, and tachycardia. It is important to be aware of these potential side-effects when using medications that affect these receptors.
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This question is part of the following fields:
- Psychopharmacology
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Question 10
Correct
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What interventions have been proven to be effective in preventing postoperative delirium and reducing its intensity and duration?
Your Answer: Haloperidol
Explanation:In elderly patients undergoing hip surgery, haloperidol has been found to decrease the intensity and length of postoperative delirium. However, it did not have an effect on the occurrence of delirium.
Delirium Management
Pharmacological management of delirium includes the use of haloperidol as a prophylactic measure. NICE guidelines recommend short-term use of haloperidol in cases where delirium is associated with distress of risk to self/others. Quetiapine is also considered a first-choice option in many units. Lorazepam can be used as an alternative if haloperidol is contraindicated, but it is more likely to cause respiratory depression, over-sedation, and paradoxical excitement.
Non-pharmacological management of delirium includes appropriate lighting and clear signage, talking to the person to reorient them, cognitively stimulating activities, regular visits from family and friends, and promoting good sleep patterns. Additional options such as donepezil, rivastigmine, melatonin, trazodone, and sodium valproate are not recommended. It is important to carefully consider the individual’s needs and medical history when choosing a management plan for delirium.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 11
Correct
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Which structure's degeneration is believed to cause the absence of cholinergic innervation observed in Alzheimer's disease?
Your Answer: Nucleus of Meynert
Explanation:The primary origin of acetylcholine in the brain is the Meynert nucleus, which is observed to be atrophied in individuals with Alzheimer’s disease. This clarifies the deficiency of acetylcholine in this disorder and the effectiveness of cholinesterase inhibitors.
Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.
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This question is part of the following fields:
- Neurosciences
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Question 12
Incorrect
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What area of the brain is affected in bilateral dysfunction that leads to Klüver-Bucy syndrome?
Your Answer: Hippocampus
Correct Answer: Amygdala
Explanation:Kluver-Bucy Syndrome: Causes and Symptoms
Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.
The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.
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This question is part of the following fields:
- Neurosciences
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Question 13
Incorrect
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At what point does Piaget's formal operational stage commence?
Your Answer: Use of language and symbols
Correct Answer: Logical thinking and hypothesis testing
Explanation:Piaget’s Stages of Development and Key Concepts
Piaget developed four stages of development that describe how children think and acquire knowledge. The first stage is the Sensorimotor stage, which occurs from birth to 18-24 months. In this stage, infants learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment.
The second stage is the Preoperational stage, which occurs from 2 to 7 years. During this stage, children use symbols and language more extensively, but they are unable to think logically of deductively. They also use a type of magical thinking and animistic thinking.
The third stage is the Concrete Operational stage, which occurs from 7 to 11 years. In this stage, egocentric thought is replaced by operational thought, which involves dealing with a wide array of information outside the child. Children in this stage begin to use limited logical thought and can serialise, order, and group things into classes on the basis of common characteristics.
The fourth and final stage is the Formal Operations stage, which occurs from 11 through the end of adolescence. This stage is characterized by the ability to think abstractly, to reason deductively, to define concepts, and also by the emergence of skills for dealing with permutations and combinations.
Piaget also developed key concepts, including schema, assimilation, and accommodation. A schema is a category of knowledge and the process of obtaining that knowledge. Assimilation is the process of taking new information into an existing schema, while accommodation involves altering a schema in view of additional information.
Overall, Piaget’s stages of development and key concepts provide a framework for understanding how children learn and acquire knowledge.
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This question is part of the following fields:
- Psychological Development
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Question 14
Incorrect
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Which receptor type is associated with uterine contracture in pregnancy?
Your Answer: Β2
Correct Answer: Α1
Explanation:Alpha-1 adrenergic receptors cause uterine contraction during pregnancy. They are linked to Gq-proteins that activate smooth muscle contraction through the IP3 signal transduction pathway.
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This question is part of the following fields:
- Neuro-anatomy
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Question 15
Correct
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Which antipsychotic is most strongly linked to sudden death?
Your Answer: Thioridazine
Explanation:Antipsychotics and Sudden Death: Thioridazine and QTc Prolongation
Antipsychotic medications are known to carry a risk of sudden death, particularly due to their effects on cardiac function. Thioridazine, in particular, has been found to have pronounced effects on potassium channels and significantly prolongs the QTc interval, which is a measure of the time it takes for the heart to repolarize after each beat. This prolongation can lead to a potentially fatal arrhythmia known as torsades de pointes. As a result, thioridazine is most strongly associated with sudden death among antipsychotics.
However, all antipsychotics carry some degree of risk for QTc prolongation and should be closely monitored for changes in this interval. This is especially important for patients with preexisting cardiac conditions of other risk factors for arrhythmias. Regular electrocardiogram (ECG) monitoring may be necessary to detect any changes in QTc interval and adjust medication accordingly. By carefully monitoring patients and taking appropriate precautions, healthcare providers can help minimize the risk of sudden death associated with antipsychotic use.
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This question is part of the following fields:
- Psychopharmacology
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Question 16
Incorrect
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With which concept of theory is Margaret Mahler most closely linked?
Your Answer: Conventional morality
Correct Answer: Autistic phase
Explanation:Mahler’s Separation-Individuation theory of child development proposes that personality development occurs in distinct stages. The first stage, the Autistic phase, occurs during the first few weeks of life, where the child is mostly sleeping and cut off from the world. The second stage, the Symbiotic phase, lasts until around six months of age, where the child sees themselves and their mother as a single unit. The third stage, Separation-Individuation, has four subphases. The first subphase, Differentiation, occurs between six to ten months, where the child begins to see themselves as an individual and experiences separation anxiety. The second subphase, Practicing, occurs between ten to sixteen months, where the child explores connections with the external world and people other than the mother. The third subphase, Rapprochement, occurs between sixteen to twenty-four months, where the child struggles to balance their desire for independence and proximity to the mother, often resulting in tantrums and the use of transitional objects. The fourth subphase, Object constancy, occurs between twenty-four to thirty-six months, where the child accepts the idea of object constancy and is more comfortable with the mother being separate for periods of time.
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This question is part of the following fields:
- Psychological Development
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Question 17
Incorrect
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What is a known complication associated with the use of valproate?
Your Answer: Cholangitis
Correct Answer: Pancreatitis
Explanation:The use of valproate can lead to pancreatitis, which is a known and potentially fatal complication.
Valproate: Forms, Doses, and Adverse Effects
Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.
Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.
Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.
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This question is part of the following fields:
- Psychopharmacology
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Question 18
Incorrect
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How can we measure the discontinuation symptoms that occur when someone stops taking antidepressants?
Your Answer: MADRS
Correct Answer: DESS
Explanation:The DESS scale is utilized to measure the symptoms that arise when antidepressants are discontinued.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 19
Correct
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In child psychology, what is the term used to describe the symptom where a child's speech is reduced to meaningless repetition of sounds, words, of phrases?
Your Answer: Verbigeration
Explanation:When a patient exhibits verbigeration, it can be a sign of loosening of association, which can also be seen in severe expressive aphasia and sometimes in schizophrenia. Knight’s move thinking is another example of loosening of associations, where the patient transitions from one topic to another without any logical connection. Neologisms are words of phrases created by the patient to describe their experiences, often related to their illness. Overinclusion is when the patient expands the boundaries of concepts, grouping things together that are not normally associated. Talking past the point, of vorbeireden, is when the patient seems to be approaching the end of a topic but never actually reaches it.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 20
Correct
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Which medications have the potential to reduce the contraceptive effect of oral contraceptives?
Your Answer: St John's Wort
Explanation:Out of the given options, only St John’s Wort is explicitly stated in the interactions section of the BNF as causing a decrease in contraceptive effectiveness. While tricyclic antidepressants are also mentioned, the BNF notes that their impact may be on the effectiveness of the antidepressant rather than the contraceptive.
Interactions with Oral Contraceptives
Psychiatric drugs such as St John’s Wort, Carbamazepine, Phenytoin, Topiramate, and Barbiturates can interact with oral contraceptives and lead to a reduced contraceptive effect. It is important to be aware of these potential interactions to ensure the effectiveness of oral contraceptives.
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This question is part of the following fields:
- Psychopharmacology
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Question 21
Correct
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What does each codon code for?
Your Answer: Amino acid
Explanation:Codons and Amino Acids
Codons are made up of three bases and each codon codes for an amino acid. There are 64 different triplet sequences, with three of them indicating the end of the polypeptide chain. The start codon always has the code AUG in mRNA and codes for the amino acid methionine. This leaves 61 codons that code for a total of 20 different amino acids. As a result, most of the amino acids are represented by more than one codon. Amino acids are the building blocks of proteins, which can form short polymer chains called peptides of longer chains called polypeptides of proteins.
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This question is part of the following fields:
- Genetics
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Question 22
Incorrect
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How can the inheritance pattern of fragile X syndrome be described?
Your Answer: X-Linked Recessive
Correct Answer: X-linked dominant
Explanation:Fragile X Syndrome: A Genetic Disorder Causing Learning Disability and Psychiatric Symptoms
Fragile X Syndrome is a genetic disorder that causes mental retardation, an elongated face, large protruding ears, and large testicles in men. Individuals with this syndrome tend to be shy, avoid eye contact, and have difficulties reading facial expressions. They also display stereotypic movements such as hand flapping. Fragile X Syndrome is the most common inherited cause of learning disability.
The speech of affected individuals is often abnormal, with abnormalities of fluency. This disorder is caused by the amplification of a CGG repeat in the 5 untranslated region of the fragile X mental retardation 1 gene (FMR1). These CGG repeats disrupt synthesis of the fragile X protein (FMRP), which is essential for brain function and growth. The gene is located at Xq27. The greater number of repeats, the more severe the condition, as with other trinucleotide repeat disorders.
The fragile X phenotype typically involves a variety of psychiatric symptoms, including features of autism, attention deficit/hyperactivity disorder, anxiety, and aggression. Both males and females can be affected, but males are more severely affected because they have only one X chromosome. The prevalence estimate of Fragile X Syndrome is 1/3600-4000.
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This question is part of the following fields:
- Genetics
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Question 23
Correct
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Which statement about neuroleptic malignant syndrome (NMS) is incorrect?
Your Answer: It is usually caused by benzodiazepine use
Explanation:When apomorphine is withdrawn, it results in a decrease in dopamine activity in the brain, similar to the effect of starting an antipsychotic medication that blocks dopamine receptors.
Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyperreflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.
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This question is part of the following fields:
- Psychopharmacology
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Question 24
Correct
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Which of the following is a first-rank symptom?
Your Answer: Thought withdrawal
Explanation:Kurt Schneider identified a set of symptoms that are highly indicative of schizophrenia, but not diagnostic. These are known as first-rank symptoms and include thought echo, third person auditory hallucinations, running commentary, made affect, made volition, made impulse, thought withdrawal, thought insertion, thought broadcast, delusional perception, and somatic passivity. Additionally, Schneider identified second-rank symptoms, which are common in schizophrenia but also occur in other mental illnesses. These include mood changes, emotional blunting, perplexity, and sudden delusional ideas.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 25
Incorrect
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Which waveform represents a frequency that is less than 4 Hz?
Your Answer: Theta
Correct Answer: Delta
Explanation:Electroencephalography
Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.
Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.
Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.
Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.
Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.
Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.
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This question is part of the following fields:
- Neurosciences
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Question 26
Correct
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Which antipsychotic has the strongest evidence to support its use in preventing postoperative delirium?
Your Answer: Haloperidol
Explanation:Delirium (also known as acute confusional state) is a condition characterized by a sudden decline in consciousness and cognition, with a particular impairment in attention. It often involves perceptual disturbances, abnormal psychomotor activity, and sleep-wake cycle impairment. Delirium typically develops over a few days and has a fluctuating course. The causes of delirium are varied, ranging from metabolic disturbances to medications. It is important to differentiate delirium from dementia, as delirium has a brief onset, early disorientation, clouding of consciousness, fluctuating course, and early psychomotor changes. Delirium can be classified into three subtypes: hypoactive, hyperactive, and mixed. Patients with hyperactive delirium demonstrate restlessness, agitation, and hyper vigilance, while those with hypoactive delirium present with lethargy and sedation. Mixed delirium demonstrates both hyperactive and hypoactive features. The hypoactive form is most common in elderly patients and is often misdiagnosed as depression of dementia.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 27
Incorrect
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What are the roles of purposes of the amygdala?
Your Answer: Fear response
Correct Answer: All of the above
Explanation:The Amygdala: A Key Player in Emotional Processing
The amygdala is a small, almond-shaped structure located in the anterior temporal lobe of the brain. As a core component of the limbic system, it plays a crucial role in emotional processing and regulation.
To better understand its function, we can use the metaphor of a car being driven on the road. The frontal lobe of the brain acts as the driver, making decisions and navigating the environment. The amygdala, on the other hand, serves as the dashboard, providing the driver with important information about the car’s status, such as temperature and fuel levels. In this way, the amygdala gives emotional meaning to sensory input, allowing us to respond appropriately to potential threats of opportunities.
One of the amygdala’s primary functions is to activate the fight or flight response in response to perceived danger. It does this by sending signals to the hypothalamus, which in turn triggers the release of stress hormones like adrenaline and cortisol. This prepares the body to either confront the threat of flee from it.
In addition to its role in the fight or flight response, the amygdala also plays a role in regulating appetite and eating behavior. Studies have shown that damage to the amygdala can lead to overeating and obesity, suggesting that it may be involved in the hypothalamic control of feeding behavior.
Overall, the amygdala is a key player in emotional processing and regulation, helping us to respond appropriately to the world around us.
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This question is part of the following fields:
- Neurosciences
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Question 28
Correct
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What is a crucial component of the brain's 'reward pathway'?
Your Answer: Nucleus accumbens
Explanation:Brain Regions and Functions
The brain is a complex organ with various regions that perform different functions. One of the key regions involved in the reward system is the nucleus accumbens (NA). This region receives input from the ventral tegmental area, which uses dopamine as a neurotransmitter. The NA is responsible for processing reward-related information and is often referred to as the pleasure center of the brain.
The limbic cortex, on the other hand, is not part of the reward circuit. It is involved in emotion, memory, and motivation.
Another important gland in the brain is the pituitary gland. This endocrine gland secretes nine hormones that are involved in maintaining homeostasis in the body.
The substantia nigra is part of the basal ganglia and is involved in movement, learning, and addiction. Although it has a role in reward-seeking, it is not considered to be part of the classic reward pathway.
Finally, the tegmentum is a region of the brainstem that contains several cranial nerve nuclei. It is involved in various functions such as movement, sensation, and autonomic control.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 29
Incorrect
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What is a correct statement about the pathology of Lewy body dementia?
Your Answer: The cerebral cortex does not tend to be atrophic
Correct Answer: There is a loss of dopaminergic neurons
Explanation:Lewy body dementia is a neurodegenerative disorder that is characterized by both macroscopic and microscopic changes in the brain. Macroscopically, there is cerebral atrophy, but it is less marked than in Alzheimer’s disease, and the brain weight is usually in the normal range. There is also pallor of the substantia nigra and the locus coeruleus, which are regions of the brain that produce dopamine and norepinephrine, respectively.
Microscopically, Lewy body dementia is characterized by the presence of intracellular protein accumulations called Lewy bodies. The major component of a Lewy body is alpha synuclein, and as they grow, they start to draw in other proteins such as ubiquitin. Lewy bodies are also found in Alzheimer’s disease, but they tend to be in the amygdala. They can also be found in healthy individuals, although it has been suggested that these may be pre-clinical cases of dementia with Lewy bodies. Lewy bodies are also found in other neurodegenerative disorders such as progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy.
In Lewy body dementia, Lewy bodies are mainly found within the brainstem, but they are also found in non-brainstem regions such as the amygdaloid nucleus, parahippocampal gyrus, cingulate cortex, and cerebral neocortex. Classic brainstem Lewy bodies are spherical intraneuronal cytoplasmic inclusions, characterized by hyaline eosinophilic cores, concentric lamellar bands, narrow pale halos, and immunoreactivity for alpha synuclein and ubiquitin. In contrast, cortical Lewy bodies typically lack a halo.
Most brains with Lewy body dementia also show some plaques and tangles, although in most instances, the lesions are not nearly as severe as in Alzheimer’s disease. Neuronal loss and gliosis are usually restricted to brainstem regions, particularly the substantia nigra and locus ceruleus.
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This question is part of the following fields:
- Neurosciences
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Question 30
Correct
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The ependyma fuse with which of the following to from the choroid plexus?
Your Answer: Tela choroidea
Explanation:The choroid plexus produces the cerebrospinal fluid (CSF) in the ventricles of the brain. It consists of modified ependymal cells. Tela choroidea is a region of pia mater of the meninges and underlying ependyma that’s a part of the choroid plexus. It is a very thin layer of the connective tissue of pia mater that overlies and covers the ependyma.
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This question is part of the following fields:
- Neuro-anatomy
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Question 31
Correct
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What is the estimated volume in which a drug is distributed throughout the body based on the plasma concentration of 0.1 mg/L after administering a 50 mg dose?
Your Answer: 500 L
Explanation:The voltage drop (Vd) is equal to the ratio of the applied voltage (A) to the circuit resistance (C). Therefore, in this case, Vd is equal to 500 volts, as calculated by dividing 50 volts by 0.1 ohms.
Understanding the Volume of Distribution in Pharmacology
The volume of distribution (Vd) is a crucial concept in pharmacology that helps determine how a drug distributes in the body. It is also known as the apparent volume of distribution, as it is an abstract volume. The Vd indicates whether a drug concentrates in the plasma of spreads out in the body. Drugs that are highly polar tend to stay in central compartments such as the plasma, resulting in a low Vd. Conversely, drugs that are more lipid-soluble are distributed widely, such as in fat, resulting in a high Vd.
The Vd is calculated by dividing the amount of drug in the body by the concentration in the plasma. Clinically, the Vd is used to determine the loading dose of a drug required for a desired blood concentration and to estimate blood concentration in the treatment of overdose. The units of Vd are in volume.
The apparent volume of distribution is dependent on the drug’s lipid of water solubility, plasma protein binding, and tissue binding. Plasma protein binding affects the Vd, as drugs that bind to plasma proteins like albumin have a smaller apparent volume of distribution. This is because they are extracted from plasma and included in drug concentration measurements, which can give a misleading impression of their volume of distribution. Understanding the Vd is essential in pharmacology to ensure the safe and effective use of drugs.
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This question is part of the following fields:
- Psychopharmacology
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Question 32
Incorrect
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This is an example of a verbal fluency test, which assesses a person's ability to generate words within a specific category of starting with a particular letter. The man demonstrated good verbal fluency for words starting with F, but his performance decreased when asked to generate words starting with A. This could indicate a difficulty with cognitive flexibility of retrieval of information.
For instance, during clinical assessment, a 70-year-old woman is asked to name animals beginning with the letter B, which she does, naming ten words in one minute. She is then asked to name animals beginning with the letter G and replies, goat, giraffe....Your Answer: Recall failure
Correct Answer: Perseveration
Explanation:To assess recall failure, the clinician typically asks the client to remember and then recall three objects after a delay. In the scenario described, the client’s difficulty cannot be attributed to a failure to maintain attention on the task, as their performance over the previous minute does not support this interpretation. However, the client’s perseveration in providing examples of words beginning with F suggests a possible issue with set-shifting, while expressive dysphasia may be identified through failure in speech of naming of objects during cognitive assessment. Disorientation, on the other hand, is typically evaluated through ten questions at the beginning of a mini-mental state examination of through screening questions during clinical assessment, and refers to a lack of recognition of place, time, of person.
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This question is part of the following fields:
- Cognitive Assessment
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Question 33
Correct
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A woman with schizophrenia in her 30s has recently changed some of her medication. She attends clinic and appears restless and states she is feeling agitated. What do you suspect could be the reason for her restlessness and agitation?
Your Answer: Akathisia
Explanation:Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
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This question is part of the following fields:
- Psychopharmacology
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Question 34
Correct
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A middle-aged individual comes to you with a visual field defect. After examination, you determine that they have a bitemporal hemianopia.
What conditions could potentially account for this particular presentation?Your Answer: Pituitary adenoma
Explanation:A pituitary adenoma can cause compression of the optic chiasm, resulting in a bitemporal hemianopia. Other tumors, such as craniopharyngiomas, meningiomas, of gliomas, can also cause this type of visual field defect. Cerebellopontine angle tumors typically present with symptoms related to the facial, vestibulocochlear, and trigeminal nerves. A cerebrovascular event in the occipital cortex can cause visual loss, usually in the form of a homonymous hemianopia. Diabetes mellitus can cause various visual defects, including diabetic retinopathy, retinal hemorrhages of detachment, and oculomotor nerve palsy. Oculomotor nerve palsies can be caused by a variety of conditions, such as vascular events, diabetic neuropathy, intracranial aneurysms, syphilis, of raised intracranial pressure. Symptoms include ptosis, diplopia, and possible mydriasis. Laser treatment for diabetic retinopathy is unlikely to cause a well-defined homonymous hemianopia.
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This question is part of the following fields:
- Neurological Examination
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Question 35
Incorrect
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What is a true statement about Torsades de pointes?
Your Answer: It is rarely asymptomatic
Correct Answer: It is often transient
Explanation:Torsades de pointes may not be present on an ECG even if the patient experiences recurring episodes, as it has a tendency to appear and disappear.
QTc Prolongation: Risks and Identification
The QT interval is a measure of the time it takes for the ventricles to repolarize and is calculated from the beginning of the QRS complex to the end of the T wave. However, the QT interval varies with the heart rate, making it difficult to use a single number as a cut-off for a prolonged QT. Instead, a corrected QT interval (QTc) is calculated for each heart rate using various formulas. A QTc over the 99th percentile is considered abnormally prolonged, with approximate values of 470 ms for males and 480 ms for females.
Prolonged QT intervals can lead to torsade de pointes (TdP), a polymorphic ventricular tachycardia that can be fatal if it degenerates into ventricular fibrillation. TdP is characterized by a twisting of the QRS complexes around an isoelectric line and is often asymptomatic but can also be associated with syncope and death. An accurate diagnosis requires an ECG to be recorded during the event. It is important to note that an increase in the QT interval due to a new conduction block should not be considered indicative of acquired LQTS and risk for TdP.
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This question is part of the following fields:
- Psychopharmacology
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Question 36
Correct
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How can we differentiate between a pseudohallucination and a true hallucination?
Your Answer: Occurs in inner subjective space
Explanation:The distinguishing factors between the two are based on personal interpretation and tangible versus intangible concepts.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 37
Correct
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What is the term that describes a patient's tendency to provide a lengthy and convoluted answer to a question, struggling to filter out irrelevant associations?
Your Answer: Circumstantiality
Explanation:Formal Thought Disorders
In formal thought disorders, changes in the speed, coherence, and cogency of thought can be observed from a patient’s speech. These disorders can also be self-reported and may be accompanied by enhanced use of nonverbal language. One possible indication is a lack of an adequate connection between two consecutive thoughts, which is called ‘asyndesis’.
There are several types of formal thought disorders, including inhibited thinking, retarded thinking, circumstantial thinking, restricted thinking, perseverative thinking, rumination, pressured thinking, flight of ideas, tangential thinking, thought blocking, disruption of thought, incoherence/derailment, and neologisms.
Inhibited thinking is about the subjective experience of the patient, who may feel that their thinking process is slowed down of blocked by an inner wall of resistance. Retarded thinking, on the other hand, is about the observed quality of thought as inferred through speech, where the flow of thought processes is slowed down and sluggish.
Circumstantial thinking refers to an inability to separate the essential from the unessential during a conversation without rendering the conversation incoherent. Restricted thinking involves a limited range of thought content, fixation on one particular topic of a small number of topics only, and a stereotyped pattern of thinking.
Perseverative thinking is characterized by the persistent repetition of previously used words, phrases, of details to the point where they become meaningless in the context of the current stage of the interview. Rumination is the endless mental preoccupation with, of excessive concern over, mostly unpleasant thoughts.
Pressured thinking, also known as crowding of thought, is when the patient feels helplessly exposed to the pressures of floods of different ideas of thoughts. Flight of ideas involves an increasing multitude of thoughts and ideas which are no longer firmly guided by clear goal-directed thinking.
Tangential thinking occurs when the patient appears to understand the contents of the questions addressed to them but provides answers which are completely out of context. Thought blocking of disruption of thought refers to sudden disruption of an otherwise normal flow of thought of speech for no obvious reason.
Incoherence of derailment is when the interviewer is unable to establish sensible connections between the patient’s thinking and verbal output, which is sometimes also called derailment. Neologisms involve the formation of new words of usage of words which disregard normal conventions and are generally not easily understandable.
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This question is part of the following fields:
- Classification And Assessment
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Question 38
Incorrect
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What would be the most suitable method to evaluate the extent of a 32-year-old man's depression?
Your Answer: GDS
Correct Answer: HAMD
Explanation:The Geriatric Mental State Schedule (GMSS) is a tool utilized to detect signs of depression among older adults.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 39
Correct
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A teenager with schizophrenia is admitted to the ward. They are assessed and appear to have both positive and negative symptoms. Which of the following assessment tools would be most useful in monitoring their psychotic symptoms?
Your Answer: PANSS
Explanation:Schizophrenia Assessment Tools: Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Symptom Scale (PANSS)
As a language model AI, I am familiar with the rating scales used to assess individuals with schizophrenia. Two of the most commonly used scales are the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Symptom Scale (PANSS). While there are many other scales available, these two are particularly important for exam purposes. The BPRS is a tool used to assess the severity of symptoms in individuals with schizophrenia, including positive symptoms such as hallucinations and delusions, as well as negative symptoms such as apathy and social withdrawal. The PANSS, on the other hand, is a more comprehensive tool that assesses both positive and negative symptoms, as well as general psychopathology. Both scales are useful in helping clinicians to evaluate the severity of symptoms in individuals with schizophrenia and to monitor their progress over time.
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This question is part of the following fields:
- Classification And Assessment
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Question 40
Correct
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At what age can a person be diagnosed with the personality disorder that is specified in DSM-5 as requiring the individual to be at least 18 years old?
Your Answer: Antisocial
Explanation:Personality Disorder: Understanding the Clinical Diagnosis
A personality disorder is a long-standing pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, clinicians must first establish that the general diagnostic threshold is met before identifying the subtype(s) present. The course of personality disorders varies, with some becoming less evident of remitting with age, while others persist.
DSM-5 and ICD-11 have different classification systems for personality disorders. DSM-5 divides them into three clusters (A, B, and C), while ICD-11 has a general category with six trait domains that can be added. The prevalence of personality disorders in Great Britain is 4.4%, with Cluster C being the most common. Clinicians are advised to avoid diagnosing personality disorders in children, although a diagnosis can be made in someone under 18 if the features have been present for at least a year (except for antisocial personality disorder).
Overall, understanding the clinical diagnosis of personality disorders is important for effective treatment and management of these conditions.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 41
Correct
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What statement accurately describes the DSM?
Your Answer: Shows better agreement between assessors than ICD
Explanation:DSM versus ICD: A Comparison of Mental Disorder Classifications
The DSM and ICD are two widely used classifications of mental disorders. While the ICD was initiated in Paris in 1900, the DSM-I was published in the USA in 1952 as a military classification of mental disorders. The ICD is intended for use by all health practitioners, while the DSM is primarily used by psychiatrists. The ICD is the official world classification, while the DSM is the official classification in the USA.
One major difference between the two classifications is their focus. The ICD has a major focus on clinical utility, with a planned reduction of the number of diagnoses in the upcoming ICD-11. On the other hand, the DSM tends to increase the number of diagnoses with each succeeding revision. Additionally, the ICD provides diagnostic descriptions and guidance but does not employ operational criteria, while the DSM depends on operational criteria.
It is important to note that the ICD has to be flexible and simple in the use of language to enable all practitioners, including those with very little formal qualifications in low- and middle-income countries, to be acceptable. Overall, understanding the differences between the DSM and ICD can help mental health practitioners choose the most appropriate classification for their needs.
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This question is part of the following fields:
- Classification And Assessment
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Question 42
Correct
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What is a true statement about the placebo effect?
Your Answer: The placebo response is greater in mild rather than severe illness
Explanation:The placebo response rate is on the rise in published studies, which is believed to be due to a larger number of patients with less severe forms of illness participating in these studies.
Understanding the Placebo Effect
In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.
Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.
The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.
It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.
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This question is part of the following fields:
- Classification And Assessment
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Question 43
Correct
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Which of the options below is inconsistent with a diagnosis of delusional disorder?
Your Answer: Delusions of control
Explanation:Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)
The Rapid Risk Assessment for Sex Offence Recidivism (RRASOR) is a well-known actuarial tool that is used to predict the likelihood of sex offence recidivism. It comprises of four items that have been proven to have predictive accuracy for sex offence recidivism. These items include the number of past sex offence convictions of charges, the age of the offender being less than 25, the offender being unrelated to the victim, and the gender of the victim.
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This question is part of the following fields:
- Classification And Assessment
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Question 44
Incorrect
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What is true about the pathology of Alzheimer's disease?
Your Answer: Senile plaques consist of hyperphosphorylated tau
Correct Answer: Enlargement of the inferior horn of the lateral ventricle is seen
Explanation:Normal ageing can exhibit both neurofibrillary tangles and senile plaques, while Alzheimer’s disease typically shows atrophy in the frontal, parietal, and medial temporal lobes.
Alzheimer’s disease is characterized by both macroscopic and microscopic changes in the brain. Macroscopic changes include cortical atrophy, ventricular dilation, and depigmentation of the locus coeruleus. Microscopic changes include the presence of senile plaques, neurofibrillary tangles, gliosis, degeneration of the nucleus of Meynert, and Hirano bodies. Senile plaques are extracellular deposits of beta amyloid in the gray matter of the brain, while neurofibrillary tangles are intracellular inclusion bodies that consist primarily of hyperphosphorylated tau. Gliosis is marked by increases in activated microglia and reactive astrocytes near the sites of amyloid plaques. The nucleus of Meynert degenerates in Alzheimer’s, resulting in a decrease in acetylcholine in the brain. Hirano bodies are actin-rich, eosinophilic intracytoplasmic inclusions which have a highly characteristic crystalloid fine structure and are regarded as a nonspecific manifestation of neuronal degeneration. These changes in the brain contribute to the cognitive decline and memory loss seen in Alzheimer’s disease.
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This question is part of the following fields:
- Neurosciences
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Question 45
Incorrect
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A 72-year-old male reports feeling distressed after hearing his deceased wife's voice in his head, asking him to come join her. He clarifies that he heard it internally and not as an external sound. What type of perceptual abnormality is reflected in his experience?
Your Answer: Auditory hallucinations
Correct Answer: Pseudohallucinations
Explanation:– Pseudohallucinations are figurative and not real
– They are located in the inner subjective space
– Auditory hallucinations are concrete, tangible, and real
– They are located in the outside objective space
– Autoscopy is the experience of seeing oneself
– Reflex hallucination is where a stimulus in one modality produces hallucination in another modality
– Hypnopompic hallucinations occur when waking up from sleep. -
This question is part of the following fields:
- Descriptive Psychopathology
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Question 46
Correct
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What is the area of the brain that is responsible for causing the Klüver-Bucy syndrome when it experiences dysfunction on both sides?
Your Answer: Temporal lobe
Explanation:Kluver-Bucy Syndrome: Causes and Symptoms
Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.
The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.
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This question is part of the following fields:
- Neurosciences
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Question 47
Incorrect
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Which class of antidepressants share a molecular structure similar to carbamazepine?
Your Answer: Tetracyclics
Correct Answer: Tricyclics
Explanation:Carbamazepine mechanism of action involves decreasing the metabolism of dopamine and noradrenaline, which is similar to tricyclic antidepressants due to their comparable molecular structure.
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This question is part of the following fields:
- Psychopharmacology
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Question 48
Correct
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Which of the following is not a part of the therapeutic community approach?
Your Answer: Dependency
Explanation:The Henderson hospital model exemplifies the four principles that underlie the therapeutic community, which include communalism, permissiveness, democratisation, and reality confrontation. These principles are reflected in the way staff and inmates interact, with a focus on mutual support and learning, tolerance of unpredictable behavior, shared decision-making, and open and honest communication about distortions from reality.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 49
Incorrect
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What is a true statement about pregabalin?
Your Answer: It does not have abuse potential
Correct Answer: It has a high bioavailability
Explanation:Pregabalin: Pharmacokinetics and Mechanism of Action
Pregabalin is a medication that acts on the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system. It is known for its anticonvulsant, analgesic, and anxiolytic properties. By decreasing presynaptic calcium currents, it reduces the release of excitatory neurotransmitters that contribute to anxiety. Despite being a GABA analogue, it does not affect GABA receptors of metabolism.
Pregabalin has predictable and linear pharmacokinetics, making it easy to use in clinical practice. It is rapidly absorbed and proportional to dose, with a time to maximal plasma concentration of approximately 1 hour. Steady state is achieved within 24-48 hours, and efficacy can be observed as early as day two in clinical trials. It has a high bioavailability and a mean elimination half-life of 6.3 hours.
Unlike many medications, pregabalin is not subject to hepatic metabolism and does not induce of inhibit liver enzymes such as the cytochrome P450 system. It is excreted unchanged by the kidneys and does not bind to plasma proteins. This means that it is unlikely to cause of be affected by pharmacokinetic drug-drug interactions.
While there is some potential for abuse of pregabalin, the euphoric effects disappear with prolonged use. Overall, pregabalin is a safe and effective medication for the treatment of various conditions, including anxiety and neuropathic pain.
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This question is part of the following fields:
- Psychopharmacology
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Question 50
Correct
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Which of the following statements about the developmental stage of adolescence is accurate?
Your Answer: States that the child realises the world is not perfect
Explanation:Melanie Klein introduced the concepts of object relations, the depressive position, and the paranoid schizoid position. The initial stage is the paranoid schizoid position, where the infant divides their ego and perception of the mother into two opposing parts, one positive and one negative. As the child grows, they come to understand that the same person can possess both positive and negative qualities, leading to the achievement of the depressive position. Splitting is a defense mechanism that prevents the integration of positive and negative object images. Isolation is another defense mechanism that involves separating the memory of an unacceptable impulse of action from the associated emotion.
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This question is part of the following fields:
- Psychological Development
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