Gurpal

Feedback: MRCPsych Paper A - December 2015

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Please post your feedback about the MRCPsych Paper A exam. If you recall any questions, please post them.

Please refrain from discussing the answers to questions on this thread. Instead, start a new thread for each question. This makes for easier reading and makes it easier for future candidates to revise.

Good luck to everyone on results day!

:)

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ECGs came up a lot - a full EMQ

LOTS OF FTDm - progranilin/MAPT

Lol - a Q on female homozygous  ratio in population if male has 1/100 recessive (?eh... Choices 1/1000, 1/4000, 1/10000, etc)

Limbic cortex- amygdala or orbital cortex (put orbital but both possible)

 

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Few repeat qs from July exams

Epigenetic research in schizophrenia

Flynn effect

IQ crystallised/fluid

Age and personality change 

Suprachiasmatic nucleus apo optic nucleus. ..function of both

Will post more....

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Oh I'm so disappointed I don't even remember the questions.

Ther was something like short arm chromosome 4, what disease is associated? 

FTD 2 questions. 1 where they asked which gene doesn't effect tau...MAP,  progranulin...

Emq antipsychotics adverse effects least likely ti cause weight gain..give 2 options

What to add with ?clozapine in case of hyperprolactenemia...i marked aripiprazole right. Don't knwo if it's right or not.

Pathological gambling...what drug causes it

Atypical depression drug of choice. I wrote phenelzine. 

Antipsychotic not metabolised in liver..amisulpride

Emq dementias. Select 2 options for each. Alzeimers lewy Huntington. Some options I remember were: intercytoplasmic inclusions, associated with parkinsonism, neurofibillary tangles, damage to ?striatum, early movement disorders.

Last Emq was related to history. Can't believe I don't remember a single option

Autosomal dominant recessive disorders... velocardial syndrome

Another MCQ from genetics fragile x syndrome x linked dominant

MCQ ?related/not related to amino acid/amino acid derivative: options ... glycine glutamate GABA acetylcholine,? Substance p...what's the answer?

Gamma hydroxy butyric acid derivative of: GABA A GABA B glutamate... can't remember all options

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Ai kicked off with DSM V and Autism Spectrum disorders classification (nearly fell off my seat - never even looked at DSM V!)

Essential criteria for antisocial PD, with a load of additional criteria to confuse - also with essential criteria for harmful use of alcohol

bipolar hormone changes/ structural brain changes

antidepressants that inhibit antipsychotics

 

AIMS and Simpson Angus came up in separate questions

questions on antipsychotics and hypotension, hyperprolacinia

Fat man on olanzapine and erectile dysfunction - what's the cause? Diabetes or huperprolactinamia

 

 

 

 

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Carrot - shaped objects in Alzheimer's - ? Hirano

which is more common in Famillial Alz - presenilin 1 or APP?

something about a CJD protein with a 5 digit number(plus letter) asking what it is used for e.g. Monitoring progress; 60% sensitivity or less reliable than EEG

asked what CT is better than MRI for ? Oedema

lateral hemianopia lesion

what illness most UNLIKELY in 3rd trimester of pregnancy - major depression, psychosis, adjustment disorder, anxiety

drug with half life of 72 hours

?fluox, aripopraze, carbamazepine 

supra optic nuclei function

supra chiasmatic nucleus function

apperceptive visual agnosia- which function spared

lots on age of child at certain milestones (including Piaget moral development that I completely missed on revision!)

Nb first word age and words galore after that!

a few questions on attachment, including one on a 'needy' patient over reliant of services

adjunctive antipsychotic to reduce hyperprolactinaemia

opioid mu receptor questions - methadone and buprenorphine

Cross over time. from MAOI to SSRI

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Im typing it for the 2nd time. Sitting in bus stupid signals were lost the 1st time i tried to post.

2 questions about agomelatin... 1 was it's least likely to cause sexual side effects. And 2nd was side effect least likely to be associated with it... some options I remember were anxiety movement disorder.

Emq: 1st ssri introduced in practice, medicine that was originally made ti treat TB,  medicine that was originally made as a general anesthesia. 

Which medicine will effect contraception...topiramate lamotrigine valproate

Pregnancy changes:increase gastric pH, forgot rest of options....and there was similar MCQ I think in old age:increase lipid and water soluble drugs , increase for lipid soluble and decrease for water soluble, decrease for both??

There was a question in which fava beans was an option. Lol can't remember anything except that. If anyone remembers please write it down.

Serotonin precursor. Tryptophan OH

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- parenting style: authoritative, authoritarian, permissive

- groupthink: how to minimise..

- learning theory: classical conditioning

- EMI on reinforcement schedule: 1) a doctor who gets an additional slot to work in each week, 2) a question on variable ratio, 3) ... 

- serial position effect : primacy effect 

- a question on which drug causes dysgeusia? 

- Flynn effect

- if both parents carry an autosomal recessive gene and are normal, how many (percentage) children will be normal and not a carrier?  

- which disease with purine metabolism disorder? 

- type of genetic study to differentiate between effect of genes and environment? 

- 54y/o with familial alzheimer's, mutation in which genes? 

- test for frontal lobe.. 

- glutamate acts on which receptor? 

- breakdown enzyme for dopamine 

- wave form in EEG: 4-7Hz

- structures in limbic system

- EMI on history of drugs: 1) first SSRI, 2) first antidepressant, 3) 

 

well, that's all i can think so far.. 

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Teratogenic effect of carbamazepine will be more harmful if combined with...lamotrigine, valproate..... what's the answer? 

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- effect of antidepressant during 3rd trimester to baby

-  in elderly, effects of hydrophilic and lipophilic drugs (increase, decrease, both, none) ... 

- in pregnant women, about distribution of drugs 

- something about CYP 3A4 i think... can't remember.. anyone can help to add on? 

- drug that causes lithium toxicity: amiloride, chlorothiazide, captopril, nifedipine

 

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Did anyone else find A1 crazy? i didn't prepare well for this exam - hence i struggled in A1. However, what was the general consensus?

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scales for montoring involuntary movements, akathisia

Flight of ideas-verbatim

Narcolepsy,

 

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Paper a 1 had a question on bowlbys model of grief and piaget moral development! Wasn't even sure such things existed

in paper 2 there was a question about dopamine metabolism and asked about which pair of enzymes. It gave options of COMT plus Mao- a, COMT plus MAO-B and MAO-a and B. I thought it was all 3!

very disappojnted with the exam. Very horrible EMQ on ECGs! 

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Its MAO B and COMT

Emq's

1.Antidepressants

2.Adverse effects:

-pathological gambling

 

 

3).Side effects of antipsychotics

-3 drugs to cause orthostatic hypotension

2 drugs which cause least weight gain

2 drugs which cause least sedation

 

4)History of drugs-psychotropics

first drug to use in aneasthesia

first drug found as NARI

first SSRI

First drug to help in TB

 

5)ECG finding

-Man has some clinical probs and pulse was  40

-man has dizziness and syncope.Pulse was 45

-man was diagnosed with memory problems and had a drug -whats teh finding

man treated with TCA-what finding

man treated with antipsychotic-stabbing chest pain,what finding

 

6)neuropathology

-2 alzheimers

2 lewy body

?huntington/parkinson

 

Any answers for this or correct my left out q's

 

 

1.

5 hours ago, aums said:

Oh I'm so disappointed I don't even remember the questions.

Ther was something like short arm chromosome 4, what disease is associated? 

FTD 2 questions. 1 where they asked which gene doesn't effect tau...MAP,  progranulin...

Emq antipsychotics adverse effects least likely ti cause weight gain..give 2 options

What to add with ?clozapine in case of hyperprolactenemia...i marked aripiprazole right. Don't knwo if it's right or not.

Pathological gambling...what drug causes it

Atypical depression drug of choice. I wrote phenelzine. 

Antipsychotic not metabolised in liver..amisulpride

Emq dementias. Select 2 options for each. Alzeimers lewy Huntington. Some options I remember were: intercytoplasmic inclusions, associated with parkinsonism, neurofibillary tangles, damage to ?striatum, early movement disorders.

Last Emq was related to history. Can't believe I don't remember a single option

Autosomal dominant recessive disorders... velocardial syndrome

Another MCQ from genetics fragile x syndrome x linked dominant

MCQ ?related/not related to amino acid/amino acid derivative: options ... glycine glutamate GABA acetylcholine,? Substance p...what's the answer?

Gamma hydroxy butyric acid derivative of: GABA A GABA B glutamate... can't remember all options

Is it not ;substance P' as its the odd out, others were amines and neurotrasmitters

 

-Partial mu receptor?-buprenorphine

full mu receptor?

partial nicotnic receptor? varencline?

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Which structures are least affected by aging - cranial nerves nucleai 

Mechanism of action of sildenafil pd5 inhibitor

Role of suprachiasmatic nucleus 

Role of preoptic nucleus - temo regulation? 

Ridiculous question on which enzime metabolises dopamine - yes comt and mao-b but also mao-a

Incidence for x linked disease in male is 1/100 what is in homozygous female? Is this where we apply the Hw equation?

Ecg mcq - clearly I need to revise a bit of ecg!

Partial agonist at nicotinic receptors? - varencicline?

Glutamate - acts on nmda rec

Swapping from ? Tca to paroxetine interval

Half life of 72 h

Localizing sign for frontal lesions - olfactory disturbances

Precursor to dopamine - l tyrosine

Where is ? Serotonin produced 

Protein 14- 3 - 3 in cjd - something about role

Which wave has a frequency of 4-7 hz theta

Compare genetics vs enviroment factors - adoption studies

Most likely to cause orthostatic hypotension

Most likely ecg change in patients taking lithium

Highest teratogenic effect when carbamazepine combined with ? Lithium 

Side effect least associated with agomelatine - constipation, anxiety, movement disorder, elevation of hepatic enzymes, something else...

Dysgustia associated with use of - lithium not an option... zopiclone, zaleplon and some others

What drug cannot be used with lithium - captopril.... 

Mode of transmission of fragile x 

Role of endosome

Neurotransmiter in autonomic ganglia

Something on risk of what in babies whos moms take ssris - hypertension - I can't remember the wording

 

 

 

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5 hours ago, fuzz123 said:

Did anyone else find A1 crazy? i didn't prepare well for this exam - hence i struggled in A1. However, what was the general consensus?

Yeh, a1 was mental , pardon the pun.

 

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9 minutes ago, robopaddy said:

Yeh, a1 was mental , pardon the pun.

 

how do they calculate the scores for paper A - I'm assuming obviously each individual paper must be passed. 

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first time sitting paper A. On the basis of yesterday, it certainly won't be the last!

Other Q's..  They asked about differentiating cerebellar with posterior column lesion
                      EMI on memory and types of memory loss
                      British Ability Scales

I'll add more as they come to me

 

6 hours ago, fuzz123 said:

how do they calculate the scores for paper A - I'm assuming obviously each individual paper must be passed. 

I believe they use the Angoff method, so the pass mark won't be related to any of our scores. Praying those sat tasked with assessing each question are kind! When I got back yesterday I searched for info on whether paper aI&aII would be marked together or separately (I also found aI awful), and it looks as though there's a chance they'll be marked together - they are only dividing Paper A into two halves for an 'interim period' until there's noone with only ai or aii left..

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3).Side effects of antipsychotics

-3 drugs to cause orthostatic hypotension

2 drugs which cause least weight gain

2 drugs which cause least sedation

options:

clozapine

olanzapine

aripiprazole

haloperdol

quetiapine

amisulpride

chlorpromazine

canr remember other options..?

 

Could anyone pls shine light on the possible answers.Its 7 answers in this q alone..

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Agreed, Paper Ai was seriously hard!  Loads in there that was not in SPMM or PsychMentor.

If I fail, not sure how to revise for the resit even!

D

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1.A boy strokes white cat and lever strikes off,whenever he des this,he hears the noise,now he is scared of going near cats..something like this?/

--?classical conditioning

2.what is the similarirty between classical and operational (associated learning wasnt there )

3.A boy talks only to his parents,later they taught him to talk to others--?stimuls generalisation

4.EMQ:

1.A man gets money for every clinic he does once in a week-?fixed ratio

2.A man gets paid his salary every month-?fixed interval

3.gambling-varaiable ratio

 

5.EMQ: choose two in sleep in prob-

-.Narcolepsy what happens- cataplexy and other one??

-.Night terrors what happens- amnesia for episode& happens in Non REM

 

6.Thematic App test-Personality test

7.Frontal lobe test?tower of london test

8.Flynn-IQ changes over generations

9.Crystal IQ vs Verbal IQ- dont know options

10-wilsons -what memory affected

 

 

 

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2 hours ago, DrDave said:

Agreed, Paper Ai was seriously hard!  Loads in there that was not in SPMM or PsychMentor.

If I fail, not sure how to revise for the resit even!

D

That is exactly how I feel.  I studied from Onexamination and psychmentor and there were huge gaps in my knowledge.  Mainly in Ai.  In the future I imagine I will have to rely more heavily on textbooks!

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4 hours ago, psychiatry2014 said:

3).Side effects of antipsychotics

-3 drugs to cause orthostatic hypotension

2 drugs which cause least weight gain

2 drugs which cause least sedation

options:

clozapine

olanzapine

aripiprazole

haloperdol

quetiapine

amisulpride

chlorpromazine

canr remember other options..?

 

Could anyone pls shine light on the possible answers.Its 7 answers in this q alone..

Risperidone

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Here's a good selection from yesterday. I found A(i) trickier than A(ii) and in general it was a difficult exam. EEG, blood supply, psychopathology, rating scales/tests were all notable by their absence.

 

Paper A(i)

Bowlby's grief model - bargaining

Autism – diagnostic categories ICD/DSM

Dissocial PD – diagnostic criteria ICD

Substance misuse – diagnostic criteria ICD

Personality disorders – diagnostic criteria ICD vs DSM

WHO and domestic violence risk factors - female

Groupthink

Cohesion/devil’s advocate/large group size – group psychology

Deaf parents and empathy – worst=normal parents deaf kid

Protective factors of pregnancy – psychosis, suicide, depression

Conditioning (monthly pay check/internet gambling/extra weekly clinic/Fixed interval/variable ratio/?variable interval

Tower of London test - executive

Thematic appreciation tests - personality

British ability scale

Flynn effect

IQ – crystallised vs fluid, changes of

Performance Iq – Ravens vs Weis

Kohlberg concrete stage

Type of attachment which would cause patient to cling to mental health services if inconsistent approach taken - ?disorganised

Maximal verbal ability in children - ?18/12 2yrs, 5yrs and 12 yrs

Autistic speech

Offered first aid – social responsibility vs empathy

Diagnosis  of PD - ICD vs DSM

Autoscopic hallucination – not diagnostic in isolation

Understanding speech – speech reception

Flight of ideas

Evidence of old CVA – lots of bilateral stuff and unilateral muscle wasting

Cerebellar tracts vs posterior tract discrimination – 2 point touch

Night terrors

Barnes Akathisia scale, simpson-angus, PANNS, clinical global impressions – rating improvement in schizophrenia, assessment of EPSES and akathisia

Classical conditioning – stroking pet whilst exposed to loud noise

Learned helplessness

Ribot’s law

Primacy effect

Parents encourage child to talk, child then talks to others - ?type of conditioning

Ethnic groups own ideas

Phonemic disorder vs specific language problem

Fundamental attributional error

 

 

Paper A(ii)

Sildenafil – phosphodiesterase 5 inhibitor

Varenicicline – partial nicotinic

Atypical depression - phenelzine

Fluoxetine/isoniazid/chlorpromazine – first SSRI (only fluoxetine listed/TB drug/antiemetic for aneathesia)

Gne for non tau FTD - progranulin

Ct vs MRI - ?rapid assessment of cerebral oedema

Birth defect in 3rd trimester SSRI - ?pulmonary hypertension

Dysgeusia - zopiclone

Changes in BiPD - Temporal horn

Deletion of tip of chromosome 4 - Wolf-Hirschorn

Autosomal dominant - digeorge

X linked question – ?1 in 10000

BMI 40, olanzapine, erectile dysfunction - DM

DaT vs Spect

Localising sign of frontal lesion - anosmia

Aripiprazole – co prescribed to offset metabolic effects

Is transcription called DNA or RNA transcription

Endosomes – cell membrane

Gene in schizophrenia at 22q - ?COMT (laos DISC1, neuregulin)

Early signs of Huntingtons

Supraoptic nucleus – temp regulation

Suprachiasmatic - circadian

Raphe nucleus - serotonin

Memory deficits – Korsakoffs, FTD

Methadone – mu, long half life

Frontal localising sign – anosmia

Ciclosporin – what would you not prescribe first line (ECT vs SSRI)

NMDA receptor - glutamate

Postural hypotension in antipsychotics – cloz, olanz, risp

Enzymes that degrade dopamine – MAOB + COMT

Carbamazepine + sodium valproate – maximal birth defects

Contraceptive pill - topiramate

Antidepressant that doesn’t inhibit cyp - reboxetine

Factor in high calcium - albumin

Theta wave frequency

Protective factors for AD - apo E2

14-3-3 testing in Creutzfeldt-Jakob disease

Principle neurotransmitter in ?ANS

Aminoacid neurotransmitters

Allosteric modification of nicotinic rec - gallantamine

Pathological gambling – trazodone

Bitemporal homonymous hemianopia – optic chiasm

Least likely s/e agomelatine – movement disorder

Cyp inhibition SSRIs vs TCAs

Aripiprazole T50

Interaction with MAOI and decongestant

GHB, which receptor

Precursor of serotonin

No hepatic metabolism – amisulpiride

Gastric emptying/volume distribution/glomerular filtration in pregnancy

Volume of distribution in elderly wrt lipophilic and hydrophilic drugs

Papez circuit – orbital ?gyrus was odd one out

Fusiform gyrus – face recognition

Pseudocholinesterase syndrome – avoid donepezil

ECGs: anterior MI (rhythm strip given)

EMQ: man having MI; torsades de pointes; heart block; PE

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British ability scale-what does it measure?

someone could shine light on it pls?

is it aptitude?

Pls clarify ''socioecmonomic status'' does not affect

?anorexia

?Bipolar

which one?

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