MRCPsych paper III March 2008 questions

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  1. Ramakrishnan

    Ramakrishnan Guest

    101. A subcultural explaination rather than a biological one in learning disabilities is most accounted for by:
    1. An even spread of LD across different socio-economic groups of the population.
    2. Moderate LD
    3. LD in other members of the family
    4. Facial dysmorphologies
    5. problems with adaptive functioning


    For Q 102 – 108 Please read the following article from the BJPsych 2007 190 :
    The table they gave us had the following factors as most significant (in order of OR and CI):
    1. Previous falls
    2. Inhaled corticosteroids
    3. Injected corticosteroids
    4. Schizophrenia diagnosis

    The article was:

    The British Journal of Psychiatry (2007) 190: 129-134.
    BJP Article

    Results:

    What followed was this table :

    http://bjp.rcpsych.org/cgi/content/full/190/2/129/TBL1</span>

    EXCEPT – all they showed us was schizophrenia, inhaled corticosteroids, injected corticosteroids, a few more (NO DRUGS!) , and they added:

    Previous Falls OR 3.2 95% CI 3-5 (This was the most significant result on the table!)

    All of these results are from the univariate analysis.






    Q102: What type of study is this?
    1. Case Control
    2. Cohort
    3. RCT
    4. Qualitative
    5. Cross sectional Survey




    Q103:: What was the most significant predictor of hip fractures?
    1. Previous falls
    2. Schizophrenia
    3. Alcohol use
    4. Smoking
    5. Weight

    Q104: Which of the following predicts more hip fractures:
    1. Schizophrenia
    2. Inhaled corticosteroids
    3. Injected corticosteroids
    4. Smoking
    5. Weight

    Q105: What can we not deduce from this study?

    1. Antipsychotics cause falls.
    2. Corticosteroids are significantly associated with hip fractures.
    3. A diagnosis of schizophrenia is significantly associated with hip fractures.
    4. 2 more choices

    Q106: According to this study, the next best step for someone who has had a fall would be to:
    1. Do a thorough falls risk assessment
    2. Check for schizophrenia
    3. Check alcohol use
    4. Check weight



    Q107: If the at risk elderly population in the UK is 55 million then the number (to the nearest thousand) at risk of a fall is (they tell us there were 16 341 cases of fractures and the sample population represents 5% of the at risk population):

    1. 27000
    2. 10000
    3. 40000
    4. 50000
    5. 60000

    Q108: Which statement is the least true:
    1. The General Practice Research Database sample is random
    2. The practices are likely to have computerised data
    3. Three more true answers

    For Q 109 – 112 please read the following précis:

    There is a well established depression scale (A) with 100 items and a scale (B) with 12 items. Scale B only takes 10 minutes to administer. Both scales A and B were administered to 100 depressed in-patients and 100 controls.

    Spearman’s correlation r = 0.8 p<0.01. High scores on A correlated with high scores on B

    Q109: Which of the following is true:
    1. A and B are highly LINEARLY correlated
    2. A is a good screening tool
    3. B is a good measure of depression.
    4. B can replace A
    5. A and B show good inter rater reliability

    Q110: Which of the following is true:
    1.Because A is longer than B it must be better
    2. A is more valid than B
    3. B is more valid than A
    4. B is more reliable than A
    5. We have not been given enough information to assess reliability



    Learning Disability

    9. You are counselling a mother who has one child with autism and is expecting her second. She wishes to know the risk of autism in this second child. You say:
    1. 1 – 10%
    2. 10 – 20%
    3. 30 -40%
    4. 40 – 50%
    5. 50-60%



    39. What increases the risk of Alzheimer’s disease in a child with Down’s syndrome?
    1. A family history of Alzheimer’s disease.

    42. In Rett’s syndrome which is incorrect:
    1. The child develops normally until 18 months.
    2. Mental deterioration precedes motor deterioration.
    3. 40-50% show self-injurious behaviour

    67. In LD which are true:
    1. Carbemazepine is associated with hyponatremia.

    68. In LD which are true:
    1. Lamotrigine is a mood stabiliser.
    2. Propanolol is a good anti-manic agent
    3. Donepezil is of proven benefit for dementia associated with Down’s syndrome



    Psychotherapy

    10. During therapy a patient suddenly blurts out near the end of the session “I am abusing my children†before quickly shifting the topic to other things. It is almost the end of the session and the appropriate thing for you to do is:
    1. Say “What do you mean by abusing?â€
    2. Keep your boundaries. End the session on time (ignoring what she has just said) and wait until the next session.
    3. Reassure her that everything said in therapy is confidential.
    4. Tell her that you have to report her to the authorities.

    11. A woman having individual psychodynamic psychotherapy with you comes in distressed saying she has had a dream about her father sexually abusing her. You:
    1. Acknowledge her distress and ask her to discuss her dream with you.
    2. Reassure her that she has not been abused.
    3. Tell her you can stop her father from abusing her by contacting the authorities.



    18.Your colleague asks you what has been shown to predict a good response in psychodynamic psychotherapy. You respond:
    1. The patient’s perception of the working alliance with the therapist
    2. Young patients
    3. Intelligent patients

    19. A man with moderate depression is unwilling to take antidepressants but will have psychotherapy. The factor which makes him suitable for brief psychodynamic psychotherapy is:
    1. He wishes to explore more about himself..
    2. There is a clearly defined psychodynamic focus.
    3. He is employed.
    4. He is less than 50 years old.

    20. A patient asks you “What is transference?†. The closest answer is:
    1. Bringing past relationships into the therapy.


    21. A patient asks you what “primary and secondary thoughts†are. You say:
    1. The primary thought is to guage the magnitude of a potential threat.
    2. The secondary thought is the negative automatic thought.
    3. The secondary thought gauges the magnitude of the threat.
    4. The secondary thought is the change in thought that comes through therapy.

    22. When Bion spoke of the “container and the contained†this – In therapy – means:
    1. Returning the patient’s difficult feelings back to them in a way they can cope with.

    62. The cognitive outcome you would hope to achieve in someone with hypochondriasis is:
    1. The complete absence of thoughts of illness.
    2. Better role functioning
    3. Less distress at thoughts of illness
    4. Better able to deal with frustration





    63. In Learning disability and psychotherapy:
    1. Anxiety management therapy is usually done for people with profound LD.
    2. Gradual muscle relaxation is done in group psychodynamic therapy.
    3. Patients with LD who have been sexually abused are treated with brief psychodynamic therapy.
    4. Unmodified CBT is used in moderate LD.
    5. Guided mourning is not useful in mild LD.



    Child Psychiatry

    12. Whilst working in child psychiatry you are dealing with a girl’s family. The girl has been abused by her father and he vehemently denies this abuse. The correct way for you to deal with the siblings of the abused child are:
    1. Have a family meeting with a suitable therapist without the abuser present.
    2. Have a family meeting with a suitable therapist and the abuser present.
    3. Have the siblings have a brief session with a psychotherapist.
    4. Residential treatment.
    5. Have the siblings see a child psychiatrist

    28. An otherwise fit and intelligent 15 year old boy has features of a moderate depressive illness. The correct treatment is:
    1. CBT
    2. SSRI
    3. CBT + SSRI
    4. TCA

    32. In children, after psychotic illnesses the next illness with a chronic poor prognosis is:
    1. Bipolar affective disorder
    2. Schizophrenic psychosis
    3. Social phobia
    4. Drug induced psychosis





    35. What treatment would you give an 8 year old with hyperkinetic disorder as first line treatment (with no other comorbidities0:
    1. Methylphenidate
    2. Atamoxetine
    3. Dexamphetamine
    4.Clonidine
    5.Imiprimine


    38. In a child with Tourettes and Hyperkinetic disorder the best treatment is:
    1. A central alpha agonist
    2. A NARI
    3. A TCA
    4. Pemoline

    43.What treatment is not indicated for a child with hyperkinetic disorder:
    1.Pemoline
    2.Imiprimine
    3. Methylphenidate
    4. Atamoxetine
    5. Clonidine.

    49. In a child with PANDAS you would expect to find raised:
    1. anti-DNAases
    2. ceruloplasmin
    3. anti-nuclear antibodies


    75. A 12 year old is brought to see you due to shoplifting. He is most likely to have:
    1. Conduct disorder
    2. Depression
    3. Oppositional Defiant Disorder
    4. Hyperkinetic Disorder






    Statistics

    13. (There is a picture of an ROC with the “knee†at 4). Which number represents the point with the best mixture of sensitivity and some specificity? (Imagine 4 is between 5 and 7 in the diagram!)


    1
    2
    3
    4
    5
    6

    14. (There is a picture of an ROC with the “knee†at 4).. What is this?
    1. A Receiver Operator Characteristics curve
    2.A Galbraith plot
    3.A Funnel plot
    4.A Scattergram
    5. A stem-leaf plot

    15. There was a normogram and we are given the pretest probability and the likehood ratio of a negative result. We are also given the ?specificity of the test and asked to calculate the post-test probability from the normogram.



    40. Which of the following reduces bias in a test:
    1. Block randomisation
    2. Intention to treat
    3. Stratification
    4. Minimisation
    5. Regression methods


    41. What does not reduce confounding:
    1. Mantzel-haentzel procedure
    2. Regression


    65. What increases the power of a study:
    1. Comparing active treatment vs placebo
    2. Comparing active treatment vs active treatment
    3. Smaller numbers of participants
    4. Increased heterogeneity








    Liaison and Eating Disorders

    15. You have a female patient with bilateral herpetic encephalopathy now presentling with increased sexual drive and carbohydrate craving. She has:
    1. Kluver-Bucy

    31. A 40 year old farmer comes to see you with general malaise, low mood, and a circumscribed 4cm red lesion on his chest. You diagnose:
    1. Chronic fatigue syndrome
    2. Lyme disease
    3. Huntingdon’s disease

    44. What treatment would you use for pathological crying?
    1. Citalopram
    2. Fluoxetine
    3. Paroxetine
    4. Venlafaxine
    5. Sertraline.

    45. What treatment has the most evidence for depression following a myocardial infarction:

    1. Citalopram
    2. Fluoxetine
    3. Paroxetine
    4. Venlafaxine
    5. Sertraline

    46. What treatment would you use for a patient with severe symptoms of premenstrual syndrome:

    1. Citalopram
    2. Fluoxetine
    3. Paroxetine
    4. Venlafaxine
    5. Sertraline






    47. What treatment has been shown to be of benefit in women with premenstrual syndrome:

    1. Light therapy
    2. Evening primrose oil
    3. SSRIs
    4. Oligoacids

    69. A lady with multiple sclerosis presents with depression. The drug most likely to be the cause is:
    1. Baclofen
    2, Beta interferon


    71. Which drug given prophylactically is shown to decrease delirium:
    1. Quetiapine
    2. Amisulpiride
    3. Haloperidol
    4. Olanzapine
    5. Risperidone





    Forensics

    16. In offending in learning disabilities:
    1. It is overrepresented by borderline and mild LD.
    2 Fire setting is the most common offense.
    3. People with LD are more likely to commit violent offences.

    17. The prevalence of psychotic disorders in prisons compared to the general population is:
    1. 5 times
    2. 10 times
    3. 20 times
    4. 40 times
    5. 50 times

    58. What percentage of people charged with sexual offences have no previous history of sexual offences?
    1. 10%
    2. 20%
    3. 50%
    4. 80%
    5. 100%


    59. What is the best predictor of future sexual offences?
    1. Previous non-sexual offences
    2. Lack of victim empathy
    3. Mental illness
    4. History of illicit drug use






    Personality Disorders

    23. People with emotionally unstable borderline personality disorder are stuck in:
    1. Winnicott’s “false selfâ€
    2. Klein’s depressed position
    3. Klein’s paranoid-schizoid position

    24. Something that is diagnostic of borderline personality disorder is:
    1. Attempts to avoid real or imagined abandonment.
    2. Depression
    3. Suicide
    4. Self-harm

    25. A young man is impulsive and has angry outbursts. He has been arrested several times for hitting his partner. His diagnosis is:
    1. Dissocial PD
    2. Emotionally Unstable PD
    3. Paranoid PD
    4. Anakastic PD



    26. A man comes to your out-patient clinic. He gives you a history in childhood of conduct disorder. He recognises that he ahs a problem with anger and often gets into fights with his partner. He wishes to prevent this from happening. You interview him and find no evidence of mental illness or active symptoms. You decide:
    1. To start no treatment but review him in three months.
    2.Start an antipsychotic and review in 3 months.
    3. Start an antidepressant and review in 3 months.
    4. To discharge him.


    Mood and Anxiety disorders

    27. A man comes to your clinic nine months after the death of his mother. You find features of a moderate depressive illness. He occasionally hears her voice calling him. You decide to:
    1. Do nothing and reassure him it will all go away.
    2. Start an antidepressant and follow him up.
    3. Start an antipsychotic and follow him up.

    33. Social phobias are most associated with:
    1. Generalising to other phobias
    2. Avoidance to reduce fear
    3. Obsessions
    4. Compulsions to reduce anxiety


    55. In generalised anxiety disorder we see:
    1. Briefly punctuated by episodes of depression
    2. Rituals
    3. Obsessions
    4. Suicide
    5. Higher dizygotic twin concordance rather than monozygotic.









    61. A woman comes into your outpatient clinic. She is obsessed with dirst and has to wash her hands up to twenty times if she touches anything. The treatment you would recommend would be:
    1. Response and Exposure prevention (Not exposure and response prevention!)
    2. CBT
    3. CAT
    4. Psychodynamic therapy
    5. Interpersonal therapy

    66.What would you do for a patient with OCD and no improvement after two months on 50mg of sertraline:
    1. Increase the sertraline
    2. Change to a different SSRI
    3. Add an antipsychotic
    4. Switch to venlafaxine
    5. Add sodium valproate






    Addiction Psychiatry

    29. You are the substance misuse consultant and are asked to draw up a service for users. The first thing to do will be:
    1. Address lifestyle imbalances

    30. Acamprosate:
    1. Can be used with controlled drinking.
    2. Is associated with abuse potential.
    3. Acts in a dose-dependent fashion.
    4. Reduces craving for alcohol.








    51. You are called to A&E to see a man withdrawing from amphetamines. He is least likely to have:
    1. Insomnia
    2. Seizures
    3. Hypersomnia
    4. Agitation
    5. Decreased appetite

    52. You are called to A&E to see someone who has taken PCP. The following are true:
    1. Gait disturbances are late
    2. Visual hallucinations are common

    53. A 19 year old tells you she takes MDMA. The least likely psychological consequence of this drug is:
    1. Anxiety
    2. Disinhibition
    3. Increased desire to do mental tasks
    4. Perceptual disturbances
    5. Increased friendliness

    60. A man who drinks two bottles of vodka a day tries to stop by himself. He is brought into hospital with ataxia, and confusion. The chances that he will develop Korsakof’s are:
    1. 10%
    2. 20%
    3. 50%
    4. 80%
    5. 100%

    Perinatal psychiatry

    36. A patient of yours is breastfeeding. She has Bipolar Affective Disorder and came off her medication for her pregnancy. She feels she is about to relapse. What medication is safe in breastfeeding:
    1. Choral hydrate
    2. Lamotrigine
    3. Sodium valproate
    4. Lorazepam
    5. Carbemazepine



    37. A female patient has had several depressive episodes in the past and one episode of hypomania. You decide the best medication to prevent relapse for her is:
    1. Lithium
    2. carbemazepine
    3. Lamotrigine
    4. Fluoxetine
    5. Sodium valproate

    34. A woman comes to see you in out-patients. She has a 6month old son and for the last three months she has recurring thoughts of harming him. She does not wish to harm him and these thoughts make her tearful and anxious. The birth was uneventful but she perceives it to have been traumatic. You diagnose:
    1.PTSD
    2. Postnatal depression
    3.OCD


    Psychiatry for Older Adults

    48. How do you differentiate that a dementia is subcortical not cortical:
    1. Calculation is preserved
    2. Apathy


    50. In an 80 year old patient compared to a 40 year old patient you would expect the half-life of temazepam to be:
    1. Reduced by 50%
    2. The same
    3. Increased by 50%
    4. Increased by 100%
    5.Increased by 200%








    Rating Scales

    56. You have started a patient with postnatal depression on an antidepressant and wish to monitor changes in her symptoms. Which of the following observer rating scales would you use:
    1. Zung
    2. BDI
    3. MADRS
    4. Morgan-Russel
    5. Edinburgh Depression Scale

    57. A young man in your clinic complains of EPSEs. The scale you would use to measure this is:
    1. Simpson-Angus
    2. Morgan-Russell
    3. Young Mania Scale
    4. AIMS (Abnormal Involuntary Movements Scale)
    5. PANSS (Positive & Negative Symptom Scale)

    58. What rating scale would you recommend for a health visitor to use to screen for depression in women after delivery:

    1. Zung
    2. BDI
    3. MADRS
    4. Morgan-Russel
    5. Edinburgh Depression Scale

    Pharmacology

    70. A male patient on clozapine has gained 20kg. Your next step is to:
    1. Switch to Quetiapine.
    2. Switch to Risperidone
    3. Add sodium valproate








    72. What drug causes symptoms of inappropriate ADH secretion:
    1. Quetiapine
    2. Amisulpiride
    3. Haloperidol
    4. Olanzapine
    5. Risperidone

    73. A man with Parkinson’s Disease develops psychotic symptoms. He has never been on antipschotics before. The best treatment for him is:
    1. Quetiapine
    2. Amisulpiride
    3. Haloperidol
    4. Olanzapine
    5. Risperidone

    74. A female patient has been trialled on Olanzapine and Quetiapine with poor effect. Your next step is to try:
    1. Clozapine
    2. Amisulpiride
    3. Haloperidol
    4. Lithium
    5. Aripiprazole



    Set 2



    Which of the following is commonly associated with microcephaly?
    1. Foetal Alcohol Syndrome
    2. Hydrocephalus
    3. Soto’s Syndrome
    4. Down’s Syndrome
    5. Fragile X Syndome

    Which of the following is true of offending in the learning disability population?

    1. Firesetting is the most commonly committed offence
    2. Most offences are committed by those with borderline and mild learning disabilities
    3. Moderate LD is strongly associated with homicide
    4. Conviction for arson leads to a fixed prison sentence
    5. Can’t remember 5th stem

    Which of the following increases the risk of Alzeihmer’s Disease in Down’s Syndrome?

    1. Positive family history
    2. Mild LD
    3. Moderate LD
    4. Smoking
    5. Aluminium exposure

    Which of the following is true of psychotropic medications in the learning disability population?
    1. Ethosuxamide is a first line antiepileptic
    2. Lamotrigine has mood stabilising effects
    3. Valproate leads to weight loss
    4. Proprananol is an effective antimanic agent
    5. Naltrexone is an effective antidepressant


    Which of the following is true about psychotherapies in the learning disability population?
    1. Unmodified CBT can be used in the severe LD population
    2. Guided mourning has no place in mild LD
    3. Part of the group psychodynamic therapy is progressive muscular relaxation
    4. Patients with severe LD who have been victims of sexual abuse should be offered psychodynamic therapy
    5. Can’t remember 5th stem


    Which of the following is most associated with reoffending in paedpophiles?

    1. lack of victim empathy
    2. psychiatric illness
    3. comorbid substance misuse
    4. previous violent offending
    5. depressed mood

    Which of the following is used as a screening tool on psychiatry?

    1. Simpson Angus Scale
    2. MADRAS
    3. SANS
    4. Edinburgh Post Natal Depression Scale
    5. BDI

    Which of the following is associated with tall stature?

    1. Prader Willi Syndrome
    2. Williams Syndrome
    3. XXY
    4. Foetal Alcohol Syndrome
    5. Cornelia De Lange Syndrome

    Which of the following is a recognised symptom of severe depression

    1. parasomnia
    2. somnambulism
    3. hypersomnia
    4. narcolepsy
    5. night terror

    Question

    One of the following is not a feature of chronic fatigue syndrome
    a. Disturbed sleep pattern
    b. Feeling tired after rest, relaxation and enjoyment
    c. Duration more than 6 months
    d. Exercise makes person more tired.
    e. Muscle aches and pains.


    Question

    Bion – principle of container and containment
    a. Therapist advises the patient to contain the feelings without letting them out.
    b. Patient has to explore the feelings within and relate them to the surroundings.
    c. Therapist doesn’t let his feelings out.


    Question

    Relative risk of ebstein’s anomaly to the baby if mother is on lithium in the first trimester of pregnancy
    a.1.5
    b. 2.5
    c. 3.5



    Set 3




    Questions 21-30 were therapy type questions:

    • Stem: What is true about the initial appraisal of an event
    Options:
    Automatic thoughts being part of primary appraisal
    Perception of the magnitude of the threat being part of primary appraisal
    Negative automatic thoughts being part of secondary appraisal
    Perception of the magnitude of the threat being part of secondary appraisal

    • What is transference ?
    Options:
    Patient’s response to the therapist based on previous relationships
    Therapist’s response to the patient
    Empathy in relationship

    • What predicts a good response to therapy?
    Options:
    Good perception of treatment alliance
    Patient can understand things in psychological terms
    Previous therapy

    • What is a core feature of emotionally unstable personality disorder
    Options:
    Attempts to avoid abandonment
    Impulsive acts
    Poor self esteem

    • What defence mechanism is best explained by a woman who says she is happy but the world and everyone in it seems depressed
    Options
    Overgeneralisation
    Externalisation
    Projective identification

    • What theorist best explains someone with emotionally unstable personality disorder?
    Options
    Winnicotts false self
    Klein’s depressive position
    Klein’s paranoid schizoid position

    • Stem: At the second session of psychodynamic psychotherapy, a distressed young woman says she dreamed she was sexually abused by her father. What do you do?
    Options:
    Acknowledge her distress and ask her to talk about the dream
    Acknowledge her distress and ask if she was abused by her father
    Leave it to the next session
    Explore the feelings it arouses in you

    • Stem: During therapy a male patient tells you that he has been sexually abusing children. He immediately starts talking about an entirely different matter. What do you do?
    Options:
    Explain that you have to contact the relevant authorities and do so
    Ask him to say more about what he means by ‘abuse’
    Change the subject
    Stop the therapy at the correctly appointed time

    • What did Bion mean by ‘containment’ in terms of therapy?
    Options:
    The therapist identifies the projected transference and projects it back safely
    The therapy is contained within a timed framework
    The therapist is able to deal with emotions as part of therapy

    • Stem: Tall stature is associated with
    Options:
    Cornelia de Lange syndrome
    Turner’s syndrome
    XYY
    Prader-Willi syndrome
    Lesch Nyhan

    • Options
    Buspirone
    Citalopram
    Desipramine
    Escitalopram
    Family Therapy
    Fluoxetine
    Haloperidol
    Lithium
    Logotherapy
    Methylphenidate
    Parental skills training
    Paroxetine
    Quetiapine
    Reboxetine
    Risperidone
    Sertraline
    Venlafaxine
    None of the above



    Lead in: Select one option each for the following

    Scenarios
    1: A 4 year old girl who is extremely aggressive towards her mother and has punched her in the stomach on one occasion. She hits other children at the nursery. She is ‘difficult’ and refused to do what she is told.

    2= A 17 year old boy with a history of frequent aggressive behaviour. Has been in trouble with the police. Parents got an injunction banning him from staying at home. He said he was aggressive almost all the time. Otherwise he has no symptoms.

    3= A 13 year old girl who is aggressive and in trouble at school. She was diagnosed by psychologist to have ADHD. She is having multi-systematic therapy but is still hyperactive and has poor attention.

    • Stem: what is the incidence of birth defects in a woman taking lithium
    Options:
    1/10
    1/100
    1/1000

    • What is the incidence of birth defects in a woman taking valproate?
    Options:
    1/10
    1/50
    1/100
    1/1000

    • What is the relative risk of psychosis in prisons?
    Options:
    5
    10
    20
    100

    • A man wants to take a herbal antidepressant. What herb would you recommend?
    Options:
    Hypericum perforatum

    • What characterises GAD
    Options:
    Depressive episodes
    Avoidance to reduce anxiety

    • What characterises phobias?
    Options:
    Avoidance to reduce anxiety
    Generalisation of phobia

    • What rating scale would you use in a woman who had given birth recently and appeared depressed in order to assess her response to antidepressants?
    Options:
    MADRS
    Edinburgh postnatal
    HAMD
    BPRS

    • What is a screening tool used in psychiatry?
    Options:
    Edinburgh postnatal

    • Stem: Which is the first line drug in an 8 year old with uncomplicated ADHD?
    Options:
    Clonidine
    Atomoxetine
    Imipramine
    Dexamphetamine
    Methylphenidate

    • Stem: Which class of drug would you use in a boy with ADHD and Tourette’s?
    A centrally acting alpha agonist
    Beta blocker
    Noradrenaline reuptake inhibitor

    • Stem: Concerning learning disability and offending
    Options:
    Most offences are committed by those with mild/mod LD
    Fire setting is the most common offence
    Those with moderate LD are most likely to be convicted of murder
    Sexual offending is related to hypersexuality

    • Stem: Select one correct statement regarding psychotherapy in LD
    Options:
    Unmodified CBT can be used in severe LD
    Guiding mourning has no place in mild LD
    Progressive relaxation is part of psychodynamic group therapy
    Patients with severe LD who have been traumatized by abuse should have psychodynamic therapy
    Behaviour therapy should be used in groups in severe LD

    • Stem: Which of the following is true concerning psychotropic medication in those with LD?
    Options:
    Lamotrigine has a mood stabilizing effect
    Propanolol is an effective antimanic agent
    Naltrexone is an effective antidepressant
    Clonazepam causes agitation


    • Stem: How would you treat an intelligent 15 year old boy with moderate depression but no suicidal thoughts?
    Options:
    CBT
    SSRI and CBT
    TCA alone
    TCA and CBT
    SSRI alone


    • Apart from psychosis which of the following disorders has the worst prognosis if onset is in adolescence?
    Schizophrenia
    BPAD
    Schizoaffective disorder
    Psychotic depression

    • Stem: In children with PANDAs which symptoms are least common?
    Options:
    Obsessions
    Depression
    Auditory hallucinations
    Anxiety

    • Stem: In PANDAs which of the following blood tests is most likely to be positive?
    Options:
    Anti DNAse antibodies
    Anti nuclear antibodies
    IgA

    • Stem: Truancy is most associated with
    Options:
    Conduct disorder
    Oppositional defiant disorder
    ADD
    Depression
    Encopresis

    • Stem: Empathy skills are most likely to be delayed in
    Options:
    A deaf child of deaf parents
    A deaf child of hearing parents
    A hearing child of deaf parents
    A hearing child with one deaf parent
    A hearing child adopted at birth

    • Options
    Angelman syndrome
    Down syndrome
    Fragile X
    Leasch Nyhan
    Phenlyketonurea
    ADHD
    Prada willi
    Rett syndrome
    Hurlers syndrome
    Hunter syndrome

    Lead in:
    A 5 year child presented with autistic symptoms and hyperphagia & hypotonia.
    B 5 year old child presented with autistic symptoms and hand wringing
    C 5 year old child presented with autistic symptoms.His maternal grandfather & maternal uncle had the condition

    • Which of the following increases the risk of Alzheimer’s disease in Down’s syndrome?
    Severe LD
    Mild LD
    Family history of Alzheimer’s
    Other brain pathology

    • Stem: Microcephaly is a characteristic feature of
    Options:
    Down’s syndrome
    Foetal alcohol syndrome
    Fragile X syndrome
    Hydrocephalus
    Soto’s syndrome


    • Terminally ill people are screened for depression with the question ‘Do you think you are depressed?’. This is then compared to a structured diagnostic interview used to diagnose depression. NB Calculators are not allowed.
    If you need more options, please add in red

    Options

    11%
    22%
    33%
    44%
    55%
    66%
    77%
    88%
    99%

    Note: gold standard at top
    Interview Depressed Not depressed
    Yes to question 11 9
    No to question 14 40
    Totals 25 49
    (1): What was the prevalence of depression in the sample?
    (2): What was the sensitivity of the screening?
    (3): What was the specificity of the screening?
    (4): What proportion of those who screened positive were depressed?
    (5): What proportion of those who were depressed screened positive?
    6) What was the negative predictive value?

    • Stem: Diagnostic features of neurasthenia include the following except:
    Easy fatiguability after minimal effort
    Poor (unrefreshing) sleep
    Muscular aches and pains
    Duration >6 months

    • Stem: Which of the following has no evidence of treatment in PTSD?
    Options:
    EMDR
    Hypnotherapy
    Stress management
    Trauma focused CBT
    Group psychotherapy

    • Stem: Huntington’s disease shows which pattern of inheritance
    Options:
    Autosomal dominant with high penetrance
    Autosomal dominant with poor penetrence
    Autosomal recessive with low penetrance
    X-linked


    • Which antidepressant has the best evidence base for its use in post MI depression?
    Fluoxetine
    Reboxetine
    Mirtazapine
    Sertraline
    Imipramine

    • Stem: Which antidepressant has the best evidence base for its use in post stroke depression?
    Options:
    Fluoxetine
    Citalopram
    Reboxetine
    Mirtazapine
    Sertraline

    • Stem: Which of the following treatments for MS is most likely to lead to depression?
    Options:
    Amantadine
    Baclofen
    Beta-interferon
    Steroids

    • Stem: A woman who has had Herpes encephalitis develops severe carbohydrate craving and weight gain. Diagnosis?
    Options:
    Cushing’s
    Diabetes mellitus
    Hypothyroidism
    Kluiver-Bucy syndrome
    Prader Willi syndrome


    • Stem: Which of the following is most common in delirium?
    Options:
    Hallucinations
    Delusions
    Disturbed sleep wake cycle
    Labile mood
    Increased motor activity

    • Stem: Which of the following are most likely to be seen in anorexia
    Option:
    High oestrogen
    Low cortisol
    High white cell count
    Low triiodothyronine
    Hyperkalaemia

    • Stem: The babies of anorexic mothers are most likely to be
    Options:
    Are large for dates
    Have lower APGAR scores
    Are born post-term
    Have a larger head circumference
    Have fetal abnormalities

    • Stem: Which of the following is least commonly associated with bulimia?
    Options:
    Oesophageal tears
    Dental decay
    Peptic ulcer
    Parotid gland enlargement
    Seizures

    • Stem: Normal bereavement is most likely to include
    Options:
    Delusional beliefs that the deceased is still alive
    Significant weight loss
    Suicidal ideation
    Worthlessness
    Transient anger to the deceased

    • Stem: Which of the following has the best evidence for its use in pre-menstrual syndrome?
    Options:
    Phenalzine
    Reboxetine
    Amitryptalline
    Fluoxetine
    Venlafaxine

    • Stem: Which of the following has the best evidence of use in pre-menstrual dysphoria?
    Options:
    Progesterone
    SSRIs
    Vitamin B6
    Bright light therapy
    Oil of evening primrose



    • Stem: Which of the following is contraindicated in the elderly with psychosis and cognitive impairment?
    Options:
    Haloperidol
    Quetiapine
    Olanzapine
    Sulpiride
    Promazine
  2. Ramakrishnan

    Ramakrishnan Guest

    MRCPsych paper 111 march 2008 EMI questions

    EMIs
    Couvade Syndrome
    Capgras Cotard’s
    Fregoli
    De Clerambaut
    Othello Syndrome
    1. An elderly woman has insomnia, low mood and weight loss. She tells you there is no point in her eating anything as her insides are rotting – Choose ONE
    2. A young man whose wife is pregnant complains of morning sickness and an inflated abdomen – choose ONE
    3. A woman with a son says that lately he tells her that her male friend has been replaced by an imposter. She keeps telling him this is not the case but he does not believe her. She has had to ask her son to leave her home because of this.
    EMI:
    1. Physical dependency in the patient.
    2. Living in an institution
    3. Male Carer
    4. Male Patient
    5. Being married to the patient
    6. Poor relationship with the patient before marriage
    7. A diagnosis of dementia in the patient
    Which of the above:
    1. Leads to elder abuse?
    2. Increase carer stress?
    3. Increase depression in the patient?
    EMI
    1.Neuroleptic malignant syndrome
    2. Cardiomyopathy
    3. Diabetes Insipidis
    4. Diabetes Mellitus
    5. Cushings
    6. DKA
    7. Delirium Tremens
    8. Lithium toxcicity
    1. A young man on clozapine complains of breathlessness and has a persistent tachycardia. Choose ONE.
    2. A woman on lithium for many years who recently complains of feeling weak. Her serum sodium is raised and she looks dehydrated.
    3. A young man started on an antipsychotic 2 weeks ago now complains of stiff muscles, fever , labile BP, and confusion.
    EMI
    Alcoholic hallucinosis
    Fahr’s syndrome
    Alcoholic delirium
    Alcohol withdrawal
    Metachromatic leucodystorphy
    Neuroacanthosis
    Systemic Lupus Erythematosis
    Complex partial seizures
    Post Herpatic encephalopathy
    1. A 44 year old homeless man is brought into A&E. he is agitated, psychotic and depressed. The ECG shows decreased alpha activity and his gait is disturbed. MRI shows hypointensity of the striatum. Choose ONE.
    2. A 25 year old man recently returned from America shows aggressive behaviour. He recently developed seizures and has periods of decreased conciousness. His full blood count and liver functions are normal – Choose ONE.
    3. A 30 year old woman has one sided facial nerve palsy and circumscribed lesions on both legs. Choose ONE.
    EMI
    Universality
    Pairing
    Dependence
    Fight-flight
    Cohesiveness
    Free floating discussion
    Interpreting transference
    Dependence
    Counter-dependence
    1. Two factors that are curative in groups.
    2. Two factors that hinder working in groups.
    3. Two factors that are found in psychodynamic groups.
    EMI
    Family therapy
    Methylphenidate
    Parenting skills training
    Other therapies
    1. A child whose mother says he is disobedient and defiant.
    2. A 17 year old whose parents have taken out a restraing order against because of his violence to them.
    3. A child who has been diagnosed with hyperkinetic disorder by the psychologist.
    EMI
    Lesch-Nehan
    Fragile X Prader-Willi
    Choose ONE:
    1. Midline repetitive hand movements
    2. History of maternal uncle and maternal grandfather with disease.
    3. History of somnolesence and increased appetite.
    EMI No psychiatric problem
    Delirium Tremens
    Alcohol dependence
    Dementia
    Korsakof’s psychosis
    Wernicke’s encephalopathy
    1. A young Japanese student whose face flushes and has nausea after two pints of beer.
    2. A patient of yours lives in a hostel and binges heavily on alcohol on weekends. On Monday morning staff at the hostel witness him having a seizure.
    3. A woman of 55 who has drank a bottle of vodka every day for many years. She has severe problems with her memory and occasional hallucinations. She is disoriented to time.
    EMI
    Case-control
    Prospective Cohort
    Cross sectional survey
    Ecological survey
    Open Label RCT
    Parallel RCT
    Cross over trial
    Qualitative study
    Which would be the most ethical (choose ONE) for the following:
    1. To look at the number of suicides following an overdose.
    2. To look at the number of children developing cardiac abnormalities in mothers on lithium.
    3. To look at obstetric complications and the development of schizophrenia but you wish to avoid attrition bias.
    4. To look for exposure and outcome whilst avoiding recall bias
    5. To compare treatment vs placebo. The trialists wish to recruit fewer participants.
    6. To compare whether a new drug has fewer side effects than another, established drug.
    7. To get patient’s perspectives on the quality of care they receive.
    EMI
    Analysis of covariance
    Paired t test
    T Test
    Chi squared test
    Choose ONE:
    1. Test to compare an antidepressant against placebo taking into account baseline differences.
    2. Test to compare recovery rates in antidepressant vs placebo at three centres
    3. Test to compare change in blood pressures in patients before and after a trial drug is given.

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