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Question 1
Incorrect
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What is accurate about the diagnosis and categorization of personality disorders?
Your Answer: Schizotypal personality disorder is included within cluster B
Correct Answer: Narcissistic personality disorder is recognised as a separate and distinct personality disorder within the DSM-5
Explanation:The DSM-5 includes a distinct classification for narcissistic personality disorder.
Personality Disorder Classification
A personality disorder is a persistent 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, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 2
Incorrect
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A clinician wishes to assess the perceived impact of antipsychotic medications on their adolescent patient with a diagnosis of schizophrenia. Which rating scale is most commonly utilized for this purpose?
Your Answer: Brief evaluation of medication influences and beliefs (BEMIB)
Correct Answer: Drug attitude inventory
Explanation:The Drug Attitude Inventory assesses the subjective effects of antipsychotic drugs in patients with schizophrenia. The ASK-20 Adherence Barrier Survey measures barriers to treatment adherence with 20 clinical items. The Brief Evaluation of Medication Influences and Beliefs (BEMIB) Scale is an eight-item Likert-type scale that evaluates the costs and benefits of medication use based on the health belief model. The Medication Adherence Rating Scale (MARS) is a 10-item self-report scale that combines elements of the Drug Attitude Inventory and Medication Adherence Questionnaire for use in patients with schizophrenia and psychosis. The Rating of Medication Influences (ROMI) Scale is a 20-item interviewer-rated scale that assesses adherence attitudes in psychiatric patients, particularly those with schizophrenia, with good inter-rater reliability.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 3
Incorrect
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What is another term for non-declarative memory?
Your Answer: Episodic
Correct Answer: Implicit
Explanation:Memory Forms
Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.
Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).
Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.
Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).
Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.
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This question is part of the following fields:
- Social Psychology
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Question 4
Correct
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What is the preferred method for identifying alcohol dependence and risky drinking in primary care settings?
Your Answer: AUDIT
Explanation:In primary care settings, AUDIT is a reliable tool for identifying both hazardous drinking and alcohol dependence, while CAGE is primarily effective in detecting dependence.
Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 5
Incorrect
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How would you describe the delusional world of a woman who seems to lack any grasp of reality?
Your Answer: Misidentified
Correct Answer: Autistic
Explanation:Delusional Structure
Delusions can be categorized based on their logical consistency and organization. Logical delusions are consistent with logical thinking, while paralogical delusions are not. Delusions can also be organized, integrated into a formed concept, of unorganized. Highly organized, logical delusions are referred to as systematized.
The relationship between delusional beliefs and reality can also be described in different ways. Polarized delusions mix fact and delusion together, while juxtaposed delusions exist side by side with facts but do not interact. Autistic delusions completely disregard actual reality, and the patient lives in a delusional world.
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This question is part of the following fields:
- Classification And Assessment
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Question 6
Correct
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For patients taking lithium once daily at bedtime and needing to determine their plasma levels, when should blood samples be collected?
Your Answer: 12 hours post dose
Explanation:Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 7
Incorrect
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Which defense mechanism is the least advanced of developed in terms of maturity?
Your Answer: Reaction formation
Correct Answer: Projection
Explanation:Projection is classified as an underdeveloped defense mechanism, as it is considered immature. Freud proposed the idea that defenses evolve along a spectrum of personality growth. As an illustration, as time passes and the connections between the frontal lobe and the limbic system continue to myelinate, the defense mechanism commonly seen in adolescence, acting out (such as impulsive and momentarily soothing outbursts), may give rise to reaction formation and potentially even altruism in the future.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 8
Incorrect
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Which factor was not identified as a vulnerability for depression by Brown and Harris?
Your Answer: Loss of a mother before the age of 11 years
Correct Answer: Significant accumulation of debt resulting in threat of eviction
Explanation:Depression (Brown and Harris)
In 1978, Brown and Harris conducted a study on 458 women in the inner London area of Camberwell to investigate the causes of depression. The study resulted in the development of a model that identified four vulnerability factors for depressive illness in women. These factors included having three of more children under the age of 14 at home, lacking an intimate relationship with a husband of boyfriend, lacking employment outside of the home, and experiencing the loss of a mother before the age of 11 years. The model emphasized the role of psychosocial factors in the development of depression.
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This question is part of the following fields:
- Social Psychology
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Question 9
Incorrect
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What benzodiazepine is recommended as the preferred medication for patients who have significant liver damage?
Your Answer: Chlordiazepoxide
Correct Answer: Oxazepam
Explanation:Sedatives and Liver Disease
Sedatives are commonly used for their calming effects, but many of them are metabolized in the liver. Therefore, caution must be taken when administering sedatives to patients with liver disease. The Maudsley Guidelines recommend using low doses of the following sedatives in patients with hepatic impairment: lorazepam, oxazepam, temazepam, and zopiclone. It is important to note that zopiclone should also be used with caution and at low doses in this population. Proper management of sedative use in patients with liver disease can help prevent further damage to the liver and improve overall patient outcomes.
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This question is part of the following fields:
- Psychopharmacology
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Question 10
Incorrect
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Which group is most commonly affected by pseudo-parkinsonism caused by typical antipsychotics?
Your Answer: Elderly males
Correct Answer: Elderly females
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 11
Incorrect
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A 28-year-old woman presents with confusion after experiencing a seizure. She has a past medical history of epilepsy and is currently under the care of the community psychiatry team. Upon examination, her temperature is 37°C, blood pressure is 138/84 mmHg, and she has a coarse tremor with a pulse of 90 bpm. Brisk reflexes and 7 beats of nystagmus on lateral gaze are also noted. What is the most probable underlying diagnosis?
Your Answer: Neuroleptic malignant syndrome
Correct Answer: Lithium toxicity
Explanation:– Lithium toxicity occurs at levels above 1.4 mmol/L
– Symptoms include anorexia, diarrhea, vomiting, ataxia, nystagmus, dysarthria, confusion, and seizures
– Fine tremor can occur in therapeutic range, but becomes coarser in toxicity
– If allowed to progress, toxicity can result in coma with hyperreflexia and increased tone, and irreversible neurological damage
– Treatment is supportive, with attention to electrolytes, fluid balance, renal function, and seizure control
– Bowel irrigation can be used in significant recent overdose, diuretics should be avoided, and haemodialysis may be required
– Benzodiazepines can control agitation. -
This question is part of the following fields:
- Psychopharmacology
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Question 12
Incorrect
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What is the extrapyramidal side-effect that is identified by a feeling of restlessness?
Your Answer: Bradyphrenia
Correct 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 13
Correct
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What is located within Brodmann area 22?
Your Answer: Wernicke's area
Explanation:Broca’s and Wernicke’s are two types of expressive dysphasia, which is characterized by difficulty producing speech despite intact comprehension. Dysarthria is a type of expressive dysphasia caused by damage to the speech production apparatus, while Broca’s aphasia is caused by damage to the area of the brain responsible for speech production, specifically Broca’s area located in Brodmann areas 44 and 45. On the other hand, Wernicke’s aphasia is a type of receptive of fluent aphasia caused by damage to the comprehension of speech, while the actual production of speech remains normal. Wernicke’s area is located in the posterior part of the superior temporal gyrus in the dominant hemisphere, within Brodmann area 22.
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This question is part of the following fields:
- Neurosciences
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Question 14
Correct
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A 25-year-old South Asian female graduate is preparing for a job interview.
She reports difficulty focusing, forgetfulness, and persistent feelings of sadness. Additionally, she experiences tension in her head and neck and occasional vision disturbances.
What culture-specific syndrome is most probable in this scenario?Your Answer: Brain fag
Explanation:Culture-bound disorders are mental health conditions that are specific to certain cultural settings and may be related to other diagnostic categories such as anxiety disorders of psychosis. Examples of these disorders include windigo and brain fag, which are depressive states, latah and piblokto, which are hysterical states, and amok, which is a dissociative state.
Brain fag is commonly observed in West African students and is a reaction to extreme stress, often related to school work. Symptoms include difficulty concentrating, memory problems, low mood, and sometimes pain around the head and neck, and blurred vision.
Amok is a dissociative state that is more prevalent in Malaysia. It is characterized by symptoms such as neurasthenia, depersonalization, rage, automatism, and violent acts.
Latah is a condition similar to Tourette’s syndrome, where an exaggerated startle response leads to abnormal behavior such as screaming, cursing, dancing movements, and uncontrollable laughter. Upon provocation, affected individuals may also shout obscene utterances, imitate a word, gesture, of action, of automatically obey commands that they would not normally follow.
Piblokto, traditionally found among Eskimo women, presents with attacks of screaming, crying, and running naked through the snow.
Wendigo is a depressive condition characterized by the delusion that one has become cannibalistic. It is mostly observed in Native Americans.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 15
Correct
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What is the most frequently reported side-effect of methylphenidate?
Your Answer: Nausea
Explanation:ADHD medications can be classified into stimulant and non-stimulant drugs. The therapeutic effects of these drugs are believed to be mediated through the action of noradrenaline in the prefrontal cortex. Common side effects of these drugs include decreased appetite, insomnia, nervousness, headache, and nausea. Stimulant drugs like dexamphetamine, methylphenidate, and lisdexamfetamine inhibit the reuptake of dopamine and noradrenaline. Non-stimulant drugs like atomoxetine, guanfacine, and clonidine work by increasing noradrenaline levels in the synaptic cleft through different mechanisms. The most common side effects of these drugs are decreased appetite, somnolence, headache, and abdominal pain.
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This question is part of the following fields:
- Psychopharmacology
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Question 16
Correct
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Which symptom is typically absent in cases of neuroleptic malignant syndrome?
Your Answer: Bradycardia
Explanation:Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyper-reflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.
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This question is part of the following fields:
- Psychopharmacology
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Question 17
Incorrect
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What is the term used to describe the process of recalling information from long-term memory triggered by a cue, such as a particular scent of sound?
Your Answer: Reconstructive memory
Correct Answer: Redintegration
Explanation:Redintegration pertains to the recollection of information from long term memory triggered by a cue, like a scent of noise. Recall entails actively searching memory stores for information. Recognition refers to the ability to identify an answer to a question from a list of options, without spontaneously recalling it. Reconstructive memory is the process of transferring information from one person to another. Relearning involves learning something again that was previously learned and forgotten, with faster learning occurring on subsequent attempts.
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This question is part of the following fields:
- Basic Psychological Processes
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Question 18
Correct
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What psychological defense mechanism is being used by a woman who was raised in foster care and creates a non-profit organization to offer guidance and assistance to other children in the system?
Your Answer: Altruism
Explanation:The defence mechanism of altruism is considered to be a sign of emotional maturity, as it involves channeling one’s own psychological distress towards aiding others.
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This question is part of the following fields:
- Dynamic Psychopathology
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Question 19
Correct
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Which of the following is believed to be the least mature at the time of birth?
Your Answer: Sense of vision
Explanation:The human visual system is incredibly intricate, but it is not fully developed when a baby is born. Although newborns can perceive shapes by tracking the intersections of light and dark lines, their vision is limited to distinguishing shades of grey. Additionally, their ability to focus is restricted to a range of 8 to 12 inches (20 to 30 cm), resulting in blurry vision. However, within a week of birth, babies born at full term should be able to recognize their mother’s facial expressions.
The Emergence of Social Smiling in Infants
Wormann (2014) discusses the emergence of social smiling in infants, which is usually interpreted as the first positive expression directed towards a cause. This occurs when an infant with an initially expressionless face examines the face of another person, and their face and eyes light up while the corners of their mouth pull upward. The age of the first appearance of the social smile varies across cultures, ranging from the fifth to seventh week. Additionally, there are differences in its duration and frequency between the second and seventh month of life. Understanding these milestones is important for a basic understanding of normal child development.
Child Development Milestones:
4 weeks Responds to noise (either by crying, of quieting), follows an object moved in front of eyes
6 weeks Begins social smiling*
3 months Holds head steady on sitting
6 months Rolls from stomach to back, starts babbling
7 months Transfers objects from hand to hand, looks for dropped object
9 months Sits unsupported, begins to crawl
12 months Cruising (walking by holding furniture)
18 months Walks without assistance, speaks about 10-20 words
2 years Runs, climbs up and down stairs alone, makes 2-3 word sentences
3 years Dresses self except for buttons and laces, counts to 10, feeds themself well
4 years Hops on one foot, copies a cross
5 years Copies a triangle, skips -
This question is part of the following fields:
- Psychological Development
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Question 20
Incorrect
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You encounter a 45-year-old man with a history of mild cognitive impairment and recurrent episodes of major depressive disorder. He was admitted to the hospital under section 3 of the Mental Health Act two months ago due to aggressive behaviour.
He reports feeling tired, sad, and lacking motivation to participate in any activities on the ward. He also reports difficulty getting out of bed in the morning. Despite being eligible for section 17 leave, he has refused to take advantage of it for the past two and a half months and spends all his time in his room.
He is currently taking fluoxetine 20 mg and PRN lorazepam for agitation. He has no known physical health issues. Your consultant has requested that you perform a blood test on him before considering adjusting his medication.
What is the most relevant blood test to request in this case?Your Answer: LFTs
Correct Answer: Vitamin D levels
Explanation:The most appropriate test to perform for this patient, who is exhibiting symptoms indicative of vitamin D deficiency due to insufficient exposure to sunlight, is a vitamin D level test. It is important to also check corrected calcium and PTH levels, as vitamin D is involved in calcium metabolism. Additionally, given the patient’s use of fluoxetine, U+Es may be checked to monitor for potential hyponatremia, while routine blood tests such as FBC, LFTS, and folic acid should also be considered.
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This question is part of the following fields:
- Assessment
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Question 21
Incorrect
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Can you identify the brain structure that is not found in both cerebral hemispheres?
Your Answer: Amygdala
Correct Answer: Pineal gland
Explanation:Neuroanatomical Structures
The pineal gland is a unique structure in the brain that is not present bilaterally. It is a small endocrine gland responsible for producing melatonin, a hormone derived from serotonin. Along with the pituitary gland and circumventricular organs, the pineal gland is one of the few unpaired structures in the brain.
In contrast, the caudate nucleus is a paired structure located within the basal ganglia. It is present bilaterally and plays a crucial role in motor control and learning.
The midbrain contains the Mammillary body, which is also a paired structure involved in long-term memory formation. These structures work together to help us remember and recall past experiences.
Finally, the supraoptic nucleus is duplicated in each cerebral hemisphere. This structure is involved in regulating water balance and plays a critical role in maintaining homeostasis in the body.
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This question is part of the following fields:
- Neurosciences
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Question 22
Incorrect
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A 25-year-old individual ingests LSD at a social gathering and begins to perceive their feet and hands as twisted and distorted. What type of body image distortion are they experiencing?
Your Answer: Hemiasomatognosia
Correct Answer: Paraschemazia
Explanation:Paraschemazia is a type of body image distortion that involves a feeling that certain body parts are twisted, distorted, of separated from the rest of the body. This can be caused by various factors, including hallucinogenic drug use, epileptic aura, and migraine. Body image distortions can be caused by both organic and psychiatric conditions. Organic causes may include Brown-Séquard paralysis, epileptic aura, and migraine, while psychiatric causes may include anorexia nervosa, hypochondriasis, depersonalization, and conversion disorders. Hemiasomatognosia is a specific type of body image distortion where the person feels that one half of their body is missing, and it can occur in epileptic aura and migraine. Other types of body image distortions include hyperschemazia, where parts of the body feel magnified in size, and hyposchemazia, where parts of the body feel diminished in size.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 23
Incorrect
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What is the procedure that entails administering the hepatitis virus to individuals with learning disabilities who are in good health?
Your Answer: Milgram experiments
Correct Answer: Willowbrook study
Explanation:Controversial studies in psychiatry have been a popular topic in exams. One such study was the Willowbrook School Study, where healthy children with learning difficulties were inoculated with hepatitis to assess the potential of gamma globulin to treat the disorder. Beecher’s study listed over 20 cases of mainstream research where subjects were experimented on without being fully informed of the risks. The Tuskegee syphilis experiment followed impoverished African-American sharecroppers with syphilis, and a significant proportion did not receive available treatment. Stanford’s prison experiment created a simulated prison environment where participants became their assigned roles, with guards becoming harsh and cruel to prisoners. The Tearooms Study involved Humphreys pretending to be a ‘watch queen’ to study men who have sex in public toilets, raising the issue of informed consent. Milgram’s Study investigated authority and obedience, where participants administered fake shocks to a confederate, with 30 participants continuing to administer shocks until 450 volts was reached. The Rosenhan experiment involved pseudopatients presenting themselves at institutions with the same symptoms and being admitted and diagnosed with serious mental disorders, leading to deinstitutionalisation.
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This question is part of the following fields:
- Social Psychology
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Question 24
Correct
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Pharmacokinetics can be described as the study of how drugs are absorbed, distributed, metabolized, and eliminated by the body.
Your Answer: Pharmacokinetics is the study of absorption, distribution, metabolism, and excretion of drugs
Explanation:Pharmacokinetics is the study of how drugs are affected by the body. This includes how drugs are absorbed into the bloodstream, distributed throughout the body, metabolized into different forms, and eliminated from the body. The acronym ADME is often used to remember these processes. Absorption refers to the transportation of the drug from the site of administration to the bloodstream. Hydrophobic drugs are absorbed better than hydrophilic ones. Distribution refers to the movement of the drug from the bloodstream to other areas of the body. Metabolism involves the conversion of the drug into different forms, often to make it more easily excreted by the kidneys. This process occurs in two phases, involving reduction of hydrolysis in phase 1 and conjugation in phase 2. Excretion refers to the elimination of the drug from the body, which mainly occurs through the kidneys and biliary system.
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This question is part of the following fields:
- Psychopharmacology
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Question 25
Correct
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A 35-year-old male patient with schizophrenia has a routine ECG showing a QTc of 480. He has no symptoms. Which psychotropic medication is most likely causing the prolonged QTc interval?
Your Answer: Haloperidol
Explanation:According to the Maudsley Guidelines, haloperidol causes the greatest increase in QTc interval among antipsychotic medications. It is important for men to have a QTc interval below 440 ms and women below 470 ms. While aripiprazole and paliperidone have not been proven to cause an increase in QTc interval, other antipsychotics, including atypical drugs like quetiapine, can have moderate to significant effects. A prolonged QTc interval, especially above 500ms, is associated with sudden cardiac death. Diazepam and other benzodiazepines have no effect on QTc interval, while amisulpride has a low effect. Citalopram is the only SSRI that has a low effect on QTc interval. Although erythromycin and other antibiotics can have an effect on QTc interval, the question specifically asks about psychotropic medications.
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This question is part of the following fields:
- Psychopharmacology
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Question 26
Correct
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What is commonly used as a measure of intelligence prior to the onset of illness of injury?
Your Answer: National adult reading test
Explanation:The NART is a widely accepted assessment tool utilized for approximating an individual’s intelligence level prior to the onset of any cognitive impairment.
The field of psychiatry uses various cognitive tests to assess different areas of cognition, including premorbid intelligence, intelligence, memory, attention, language, and others. Some commonly used tests include the National Adult Reading Test (NART) for premorbid intelligence, the Wechsler Adult Intelligence scale (WAIS) and Raven’s Progressive Matrices for intelligence, the Rey-Osterrieth Complex Figure for memory, and the Stroop test, Wisconsin card sorting test, Tower of London, and Continuous Performance Tasks for attention. The Boston naming test and Animal fluency are used to assess language skills. The Halstead-Reitan battery is used specifically for assessing brain damage. These tests are often included in the MRCPsych exams.
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This question is part of the following fields:
- Classification And Assessment
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Question 27
Incorrect
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A forensic psychiatrist evaluates a woman in custody who is accused of murdering her 4 year old daughter. The woman has a background of schizophrenia. She confesses to the psychiatrist that she committed the crime and provides a detailed description of the event. The psychiatrist observes that although she appeared somewhat disturbed by her recollection of the incident, her level of disturbance was significantly lower than anticipated. What does this imply?
Your Answer: Incongruity of affect
Correct Answer: Blunt affect
Explanation:The women’s affect is not flat as she displays some emotions, but they seem to be blunted and less intense than anticipated. However, her emotions are appropriate and in line with the situation, indicating that they are not incongruous.
Mental State Exam – Mood and Affect
Affect is a term used to describe a patient’s present emotional responsiveness, which is indicated by their facial expression and tone of voice. It can be described as being within normal range, constricted (where the affect is restricted in range and intensity), blunted (similar to constricted but a bit more so), of flat (where there are virtually no signs of affective expression). Mood, on the other hand, is a more prolonged prevailing state of disposition. A feeling is an active experience of somatic sensation of a passive subjective experience of an emotion, while an emotion is best thought of as a feeling and memory intertwined. Apathy is the absence of feeling. It is important to distinguish between affect and mood, as affect is momentary and mood is more prolonged.
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This question is part of the following fields:
- Classification And Assessment
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Question 28
Incorrect
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How can the four principles of medical ethics be stated?
Your Answer: Autonomy, Beneficence, Confidentiality and Justice
Correct Answer: Autonomy, Beneficence, Non-maleficence and Justice
Explanation:Ethical theory and principles are important in medical ethics. There are three key ethical theories that have dominated medical ethics: utilitarianism, deontological, and virtue-based. Utilitarianism is based on the greatest good for the greatest number and is a consequentialist theory. Deontological ethics emphasize moral duties and rules, rather than consequences. Virtue ethics is based on the ethical characteristics of a person and is associated with the concept of a good, happy, flourishing life.
More recent frameworks have attempted to reconcile different theories and values. The ‘four principles’ of ‘principlism’ approach, developed in the United States, is based on four common, basic prima facie moral commitments: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to make their own decisions, beneficence refers to the expectation that a doctor will act in a way that will be helpful to the patient, non-maleficence refers to the fact that doctors should avoid harming their patients, and justice refers to the expectation that all people should be treated fairly and equally.
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This question is part of the following fields:
- Social Psychology
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Question 29
Correct
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A 35-year-old woman has been informed that her mother has frontotemporal dementia with parkinsonism. She is curious about the likelihood of inheriting the same condition. What genetic mutation is linked to this disorder?
Your Answer: MAPT gene mutation
Explanation:Down’s syndrome is caused by the presence of an extra copy of chromosome 21, also known as trisomy 21. This genetic condition is characterized by developmental delays, intellectual disability, and distinct physical features.
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This question is part of the following fields:
- Genetics
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Question 30
Incorrect
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Which of the following is not a component of the syndrome of frontotemporal lobe degeneration (FTLD)?
Your Answer: Pick's disease
Correct Answer: Posterior cortical atrophy
Explanation:Frontotemporal lobe degeneration (FTLD) encompasses various syndromes, such as Pick’s disease, primary progressive aphasia (which impacts speech), semantic dementia (affecting conceptual knowledge), and corticobasal degeneration (characterized by asymmetrical akinetic-rigid syndrome and apraxia). It is important to note that posterior cortical atrophy, which involves tissue loss in the posterior regions and affects higher visual processing, is not considered a part of the FTLD syndrome.
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This question is part of the following fields:
- Neurosciences
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