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April 2015 MRCPsych Paper B - Feedback

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This topic is for everyone who has taken the MRCPsych Paper B exam. Please give your feedback! If you remember any questions from the Paper B exam, please post them!

 

Good luck on results day!

 

:D

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I would not be surprised if the pass mark comes less than 40%! Everybody was complaining about how tough and weird the paper was.

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Very difficult paper, sounds like I'm not the only one who struggled with this.

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Despite the exam-induced mental block & apart from the extraordinary critical appraisal questions, I'll try and post what I could remember....

-most common symptom in post partum psychosis

I chose affective symptoms. Other options included hallucinations and delusions.

-sign of psychosis in deaf child/adolescent?

Options included noise in external space, hearing voice inside head, seeing a person signing in his head, being anxious all the time. I think I chose the last one.

.......

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-I think there was a question ab relationship between idealisation and splitting? Or something like that.

-what is the most common presentations of wernicke enephalopathy? Options included: confusion and ataxia and ophthalmoplegia, confusion and ophthalm, ophthalmoplegia, confusion and ataxia. !!

I think I picked confusion and ophthalm. Since the triad is rare but now i have a feeling it's ophthalm only is the most common present.!

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Struggled with the statistic I had no clues

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The only questions I can seem to remember are the critical appraisal ones! Will have a nap and then hopefully post more specific details, as my brain is over worked right now...

Paper B started off with a critical appraisal question about two different tests for depression with high Spearmans of 0.81 or something, questions asking about what conclusions does this draw.

A forest plot of antidepressant vs placebo was given, lots of questions about calculating EER, CER, ARR from various parts of the forest plot, relatively okay to calculate (compared to the rest of the critical appraisal/stats questions!).

A qualitative study also given looking at stereotypes of asian medical students in a London medical school

An economic analysis plot, probability vs willingness to pay for TCAs vs SSRIs vs something else. Questions about cost effectiveness of the different treatments.

A ROC curve for a diagnostic test, questions about most specific point, most sensitive point, point which brings both benefits and harms.

No funnel plot, Galbraith plot, l'abbé plot, stem and leaf plot in sight...

Can't remember much else right now...will post again later!

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Dx of a 9year old with symptoms of adhd. I chose CBCL

Dx of autism in 10 year old.i chose ados

Cognitive assessment of 10 year old. I wrote WISC.

Question on delirium differentiation: of given options I chose sleep wake cycle.

Question on ssri withdrwl:dizziness .Can't remember the second choice give.

Question:most common symptom post partum psychoses .I chose persecutory delusion.

Ratio of bulimia is 1.10. Autism 4:1,

Adhd 4:1

Question on someone with tics vocal and motor for 12months. I chose touretts.

Emi: 2 options for fragile X. I chose avoidance of gaze and second option I gave was Ocd .same emi asking about 2 options for retts. I chose hand wringing n Ocd.

Most prone to psychoses: of given choices I chose angelman.

Child 8 years expelled from school n involved in truancy. I chose conduct disorder.

Question on asperger causing? I chose arson of other options like RTA n fire setting.

Mentally ill patients are more prone to violent acts due to pwrsecutory delusions.

A question on depress and LD.

I chose downs modifying depression.

A question on elderly male on suicide:

I chose overdoses on hanging which I think is wrong.

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Question 23 I remember because I always find it annoying when the exact answer is not in the options and they have rounded the answer to the extent doubt is introduced.

 

Q23) The prevalence of a condition is 10%. A test has a sensitivity of 95% and a False positive rate of 5%. What is the Post positive test probability?

 

LR+=.95/0.05=19. Pre-test odds= 1/9.

Post test odds =19/9

so post test probability=19/9 / (19/9 + 1) = 68%

 

They gave D) 58% and E) 70%

So as E was the closest I guess that is the 'correct' answer although a bit confusing they give answer D to 2 sig figs but then round E appears to be rounded to the nearest 10!

Edited by eve1
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I don't recall having to do any complicated calculations for the post test probability.

After finding LR, I just plotted it on the nomogram then

All I did was read it straight off Fagan's nomogram with the available data.

Edited by SuperDoc
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Emi;

Behaviour therapy I answered flooding and systematic desensitisation.

Dbt:mindfullness.

Cat; maladaptive behaviour

Emi study designs

Case control: cjd

Question on Friedrich ataxia, patient falling with MI and visual hallucinations.

Question on a tool which finds adhd and also finds autism. I chose divergent validity.

Repeat questions of WEMBS but different questions.

Repeat questions;

London medical school Asians students

Forest plot: ssri nd placebo graph

Fanagan nomogram

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Hard exam but I'm holding onto hope.

Can't remember many questions in full but maybe my prompts will help others. Many from recent iterations of the exam:

EMI: Depression treatment options in 2nd trimester pregnancy: choose 2

Depression treatment options in breastfeeding: choose 2

Options incl: Sertraline, Venlafaxine, Amitriptyline, Imipramine

EMI: diagnosing childhood disorders:

9 yrs old, suspected autism, interview pt directly: I chose Autism Diagnostic Interview (over ADOS, but ADOS is the right answer)

7 years old, diagnose ADHD (Conners)

Cognitive Assessment 10 year old - I chose WISC

1st q was two depression scales (A is validated, B is new) have high Spearmans coefficient, tested in depressed inpatients vs non-depressed on electoral roll. Depressed inpts scored much more highly than controls on either scale.

1st: Are they linearly associated, or A highly reliable replacement for B, or B highly replacement for A. I chose B highly reliable replacement for A .

2nd: q on validity of the tests in measuring depression - I chose 'not enough info to comment on validity of either scale'

3rd: q on study methodology: I chose the investigators shd collect the scores on each scale blinded to the patients results on the opp scale. Other options included - "inclusion of depressed inpatients inappropriate for this type of study due to the severity of their depression".

Q on agitated patient who has presented with symptoms of confusion, tremor and rigidity - which drug shd be used with caution to treat: either antimuscarinics, antipsychotics, cholinesterase inhibitors, benzos, L dopa, etc. I thought it was NMS but could not remember treatment remembered bromocriptine but didn't know what it was - chose antimuscarinics but I think benzos is the answer for agitation in NMS.

Edited by daisyfrau
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Question 23 I remember because I always find it annoying when the exact answer is not in the options and they have rounded the answer to the extent doubt is introduced.

Q23) The prevalence of a condition is 10%. A test has a sensitivity of 95% and a False positive rate of 5%. What is the Post positive test probability?

LR+=.95/0.05=19. Pre-test odds= 1/9.

Post test odds =19/9

so post test probability=19/9 / (19/9 + 1) = 68%

They gave D) 58% and E) 70%

So as E was the closest I guess that is the 'correct' answer although a bit confusing they give answer D to 2 sig figs but then round E appears to be rounded to the nearest 10!

I remember this because I spent 20min trying to convert pretest probability to post test odds then back to post test prob! Really messed me up as far as timing concerned! It was only at end of exam revising that I remembered the nomogram on the previous page! Using pretest prob and my calculated LR+ of 0.171 I was able to draw line and read off the answer, and same for next q. Edited by daisyfrau
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MRI showing widespread white matter changes with cortical sparing. Knew it was a sub cortical dementia but did not know which waaah.

I can't remember if this was the same q as person with history of migraine and stroke - in which case it was CADASIL. Otherwise think it's Binswangers. I didn't put either answer down unfortunately - I think I chose Lewy Body bizarrely....

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For once I thought critical appraisal & stats was better than the clinical qs. I'm hoping to recover points there...

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The answer was Cadasil

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Regarding EMQ on statistical tests:

I think four EMQs in total.

First one I chose Anova.

Another EMQ was wilcoxin ranked pairs.

Another one was Chi-square test.

Can't remember the fourth one.

Does anyone agree with my answers?!!!

Edited by SuperDoc

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Regarding qts on confusion, rigidity and tremor.which RX to avoid?

I chose antipsychotics, for the simple reason that it may be a presentation of Dementia of Lewy bodies.

So obviously there is neuroleptic sensitivity

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I chose anova, paired t test, chi square and mann-Whitney - I think.

What abt that crazy hard one on anti epileptics -

One safe in (or was it causes?) liver failure (chose topiramate, had no idea)

One causes visual field defects (chose vigabatrin)

One does not interact with many other drugs (chose lamotrigine, but ???)

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Regarding qts on confusion, rigidity and tremor.which RX to avoid?

I chose antipsychotics, for the simple reason that it may be a presentation of Dementia of Lewy bodies.

So obviously there is neuroleptic sensitivity

I may be wrong but I interpreted question to be what drug SHOULD be used, with caution. I thought the presentation was NMS. But I chose the wrong answer all the same.

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The patient had agitation which needed treating in the context of that presentation...

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