SPMM MRCPsych sample

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Lena Palaniyappan

MRCPsych Paper 1 solved sample (June 2008)

47. What is the number of women that have been reported being amputated in the genital area (June 2008)

A. 100, 000

B. 1 million

C. 10,000

D. 10 millions

E. 100 millions

Ans: E Female genital mutilation (FGM) includes procedures that intentionally alter or injure female genital organs for non-medical reasons. An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM. In Africa, about three million girls are at risk for FGM annually. The procedure has no health benefits for girls and women. Procedures can cause severe bleeding and problems urinating, and later, potential childbirth complications and newborn deaths. It is mostly carried out on young girls sometime between infancy and age 15 years.

Source: WHO factsheet on FGM; http://www.who.int/mediacentre/factsheets/fs241/en/

49. Average age of puberty in boys is (June 2008) A. 8-9 years

B. 10-11 years

C. 9-10 years

D. 11-12 years

E. 14-15 years

Ans D. In UK the average age of onset of puberty in males is 11.2 years; for females it is 11 years. Menarche on average is at 12.5 years for females. There is a general trend for falling in menarcheal age globally over last 50 years. Compared to US and other European countries this falling trend is smaller in UK (by about 6 months in 30 years). Social stress is also a puberty accelerator, with familial disruption and father absenteeism, being one of the most effective stressors. Precocious puberty is suspected in boys before age 9, and girls before age 8.

Parent A, Teilmann G, Juul A, et al. The timing of normal puberty and age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003;25:668–93.

50. Alexia without agraphia (pure alexia) is seen in lesions of (June 2008)

A. Anterior cerebral territory

B. Posterior cerebral territory

C. Middles cerebral territory

D. Posterior inferior cerebellar artery

E. Middle meningeal artery

Ans: B Alexia without agraphia almost always involves an infarct to the left posterior cerebral artery affecting splenium of the corpus callosum and left visual cortex. So the affected person, who is still able to see with right visual cortex, cannot undertake lexical word processing making him unable to read. But he can still write normally.

Ref: Strub & Black The Mental stae examination in Neurology 3rd ed.

108. The following is the most common obsession in OCD (June 2008)

A. Checking

B. Magical thinking

C. Rumination

D. Fear of contamination

E. Symmetry

Ans: A. The most common obsession is fear of contamination, followed by pathological doubt, a need for symmetry, and aggressive obsessions. The most common compulsion is checking, which is followed by washing, symmetry, the need to ask or confess, and counting.

Swedo SE, et al. Obsessive-Compulsive Disorder in children and adolescents: Clinical phenomenology of 70 consecutive cases. Arch Gen Psychiatry 1989;46:335-41

93. An anorexic patient repeatedly purges with laxatives. Which of the following is a possible complication? (June 2008)

A. Metabolic alkalosis

B. Metabolic acidosis

C. Hyperkalaemia

D. Hyponatraemia

E. None of the above

Ans. B. During laxative induced diarrhoea, a large amount of bicarbonate may be lost in the stool. With normal kidneys, the lost bicarbonate is replaced effectively and a serious base deficit does not develop. When there is poor renal blood flow due to hypovolaemia/starvation, base deficit and acidosis develop rapidly. Acidosis also results from excessive production of lactic acid when patients have severe diarrhoea.