MRCPsych Paper 3 MCQs Spring 2008

Answers are marked red. Please indicate mistakes in comments box. Set 1

Q. 1. A sociocultural explanation rather than a biological one in learning disabilities is most accounted for by: 1. An even spread of Learning Disability across different socio-economic groups of the population. 2. Moderate Learning Disability 3. Learning Disability in other members of the family 4. Facial dysmorphologies 5. Problems with adaptive functioning

Answer:5. Problems with adaptive functioning http://64.233.183.104/search?q=cache:2qOlrDexzL4J:www.dmacc.edu/Instructors/acstevens/241ppts/comer5e_lecture_Ch03.ppt+socio-cultural+model+Mental+Retardation&hl=en&ct=clnk&cd=3&gl=pk

Questions 2-8 For question 2 – 8 Please read the following article from the BJPsych 2007 190 : 129-134View Table The table they gave us had the following factors as most significant (in order of Odds Ratio and Confidence Intervals) 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 ArticleResults: What followed was this table : http://bjp.rcpsych.org/cgi/content/full/190/2/129/TBL2

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.

Q. 02: What type of study is this? 1. Case Control 2. Cohort 3. RCT 4. Qualitative 5. Cross sectional Survey

1. Case Control

Q. 03:: What was the most significant predictor of hip fractures? 1. Previous falls 2. Schizophrenia 3. Alcohol use 4. Smoking 5. Weight 5. Weight

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

Q 5: 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. Cerebrovascular disease is significantly associated with hip fractures. 5. Hormone Replacement Therapy is protective against hip fractures 3. A diagnosis of schizophrenia is significantly associated with hip fractures.

Q 6: 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

4. Check weight

Q 7: 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

2. The practices are likely to have computerised data The general practice Database was ranom though there was some selection bias toward large practices.

For Q 08 and 09, 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

Q 08: 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

1. A and B are highly LINEARLY correlated Spearman's is near enough to 1( i.e. 0.8 )and p-value is less than 0.01 hence there is a strong correlation. The range of all coefficients is from -1 to +1.

Q 09: 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

5. We have not been given enough information to assess reliability

Learning Disability

Q 10. 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%

2. 10 – 20%

ASD has a strong genetic component, but it's not as simple as you might imagine. In general, the likelihood of having a child with ASD is about 1 in 166. Once a couple have had one child with ASD, their risk of recurrence rises to somewhere between 1 in 50 and 1 in 12.Reference:http://autism.about.com/od/medicalissuesandautism/f/geneticsfaq.htm

Q11. What increases the risk of Alzheimer’s disease in a child with Down’s syndrome? Answer: A family history of Alzheimer’s disease.

Q12. In Rett’s syndrome which is incorrect: 1. The child develops normally until 18 months. This is false and thus the desired answer. There are developmental delays before 18 months too, though symptoms become more characteristic after 18 months. 2. Mental deterioration precedes motor deterioration. This is also true. Although motor "delay" can occur before onset of mental symptoms, but motor "deterioration" per se occurs after mental deterioration. 3. 40-50% show self-injurious behaviour This is true. According to one study 49% of patients self harm. http://www.emedicine.com/PED/topic2653.htmhttp://www.ncbi.nlm.nih.gov/pubmed/8335149 http://books.google.com.pk/books?id=Q6xkh3QdyGEC&pg=PA29&lpg=PA29&dq=Rett+'s&source=web&ots=tAq_-cR5jq&sig=Qml4nS_eYoBddZu4scvlJTwY3Dw&hl=en#PPA30,M1

Q13.

In LD which are true: Answer:1. Carbemazepine is associated with hyponatremia.Maudsley Prescribing Guidelines.

Q14. In relation to Learning Disability which of the following statements is true: 1. Lamotrigine is a mood stabiliser. FMood stabilizer otherwise but not used as mood stabilizer in population with LD 2. Propanolol is a good anti-manic agent FalsePropranolol is used for aggression occasionally but not as anti-manic 3. Donepezil is of proven benefit for dementia associated with Down’s syndrome TRUE Ref. Seminars in Learning Disability

Psychotherapy

Q15.

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?” 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.

1. Say “What do you mean by abusing?”

This is my guess as first we need to know what the person means by abuse. In a person's thinking, it may be a thing that he has not seen his children for 3 days and that may be in context of his psychomotor poverty or retardation in context of schizophrenia or depression.

Q16.

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.

1. Acknowledge her distress and ask her to discuss her dream with you.

Q17. 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

1. The patient’s perception of the working alliance with the therapist

Q 18. 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.

Q19. A patient asks you “What is transference?”. The closest answer is: 1. Bringing past relationships into the therapy.

Q 20. 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.

Q 21. 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.

Q 22. 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

23. 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

24. 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

25. 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

26. 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

27. 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 disord 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 self” 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