psychiatry2014

Paper B April 2018 Feedbaback

30 posts in this topic

Posted (edited)

Hello everyone..

How did you find today's paper B?

Edited by psychiatry2014

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41 minutes ago, psychiatry2014 said:

Hello everyone..

How did you find today's paper B?

time was an issue. nothing came from SPMM. i left out 25 questions. this was my second time. Please share todays recall questions. 

i have recalled some and still working on it.

1.Haloperidol and sertraline OD ,presented with high fever,tachycardia, high BP, muscle rigidity, fluctuation of consciousness,
2.type  of conduct disorder
3.Why are you scowling at me on disagreements  ? 
Interview technique
clarification
4.You did not mention meeting with manager ? She was excited about the meeting a year ago
Confrontational
5.38 year old gentleman with depression. What antidepressant has no sexual side effects ?
Citalopram
Mirtazapine
6. turning into an exciting opportunity what seemed to be a challenging task
7.Test for executive function in mild cognitive impairment
Clock drawing
Information from informant on activities of daily living
8. ECG
Pericarditis
Citalopram and QT prolongation
Hypokalemia in vomiting and laxative diarrhoea anorexic girl – U wave
9. common psychiatric disorder after diagnosis of cancer
Adjustment disorder
10. what is true regarding risk assessment 
Historical factors more important than clinical factors
HCR 20 most commonly used
Structured professional judgement more important than clinical judgement
11. regarding predicting repeating offences in antisocial personality disorders
Static factors important
Dynamic factors important
12.your consultant found out some problems in performance and asked you to address problem.which will you do first ?
Audit
Qualitative study
 

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It was very lengthy and questions were quite unusual. 

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Some questions i know now i got wrong!!! Ahhhhh

1. Di George Syndrome is associated with Schizophrenia

2. L.D. disorder associated with purine metabolism is Lesch Nyhan

3. Fishy smell illicit drug is Methadrone

4. Ecg question about anorexia

5. Ssri drug and sexual complaint

6. Lithium toxicity

7. Lewy body dementia PROBABLE diagnosis feature

8. What is most common group of murder victim for a psychotic lady?

9. % range for epilepsy rates in an adolescent with autism

10. Cocaine with the young man in a&e with dysphoria

11. Alcohol damage to certain part of brain

12. Prisoner who shoplifted on remand, what ward to go to when goes manic

13. Stable bipolar lady on valproate and olanzapine...wants to become pregnant via fertility treatment. Next step?

14. % range of MCI that convert to Alzheimers each year

15. Diagnosis of man in 80's with memory problems for 3 yrs and ace3 score 68 who has a son with huntingdons and a deceased sister with alzheimers

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I think the exam was not an easy one, specially  the critical appraisal part. this is the first time is sat for paper b . Any one who sat before can tell us if it was harder or the same as the previous exams

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1 hour ago, Norah50 said:

I think the exam was not an easy one, specially  the critical appraisal part. this is the first time is sat for paper b . Any one who sat before can tell us if it was harder or the same as the previous exams

the questions were lengthy,new.critical appraisal was similar in hardness but new questions which took me long time to analyse. please post as much recall questions as possible. repeat of new questions is 40 percent

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I don't get why the pass mark for paper B has always been high (67-70). It's so different to Paper A where I had an hour to spare and despite the exam being relatively good the pass mark was "lowish" at 65. I've never rushed through an exam like I did with this one, time wasn't an issue with the SPMM mocks. The last EMI question where you had to pick 2 answers is something I didn't notice and quite a few people didn't see that as well (probably because of the lack of time).

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16 hours ago, robopaddy said:

Some questions i know now i got wrong!!! Ahhhhh

1. Di George Syndrome is associated with Schizophrenia

2. L.D. disorder associated with purine metabolism is Lesch Nyhan

3. Fishy smell illicit drug is Methadrone

4. Ecg question about anorexia

5. Ssri drug and sexual complaint

6. Lithium toxicity

7. Lewy body dementia PROBABLE diagnosis feature

8. What is most common group of murder victim for a psychotic lady?

9. % range for epilepsy rates in an adolescent with autism

10. Cocaine with the young man in a&e with dysphoria

11. Alcohol damage to certain part of brain

12. Prisoner who shoplifted on remand, what ward to go to when goes manic

13. Stable bipolar lady on valproate and olanzapine...wants to become pregnant via fertility treatment. Next step?

14. % range of MCI that convert to Alzheimers each year

15. Diagnosis of man in 80's with memory problems for 3 yrs and ace3 score 68 who has a son with huntingdons and a deceased sister with alzheimers

Thank you for posting these. Would appreciate if you post more. 

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I found the exam very difficult too! Can anyone remember any of the critical appraisal/stats questions??

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Posted (edited)

Random stuff from my memory regarding April 10 paper A exam

 

Path analysis (4 questions)

Weird questions about conduct disorder

Weird questions about school behavior program 

gene of schizophrenia HLA******

Epislepsy in autism patients

lewy body dementia management (3 questions)

4 questions on ECG interpretations and scenarios 

 

Edited by Sultan

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Study re clusters practices in ethnic monorities in south London  the calculation hard enough although there is an spmm example of a similar one a lot of time for half a mark . Conduct disorder was wether you knew ICD sub classes . Very oddly phrased questions and plenty of marginal calls as in the LB question

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Some more questions i can remember....

1. &2.  Couple more questions about prisoners and what you do in certain examples.... one was to send a collapsed patient to A&E..  another one was a prisoner who murdered someone, and was now becoming completely unmanageable on ward, think it was a secure/locked unit

3..bit of clarification about the mci patoent converting to alzheimers....question was actually quite specific about which type of mci,, Amnesic MCI....i think that means the conversion rate is quite high,>30% compared to mci

4. LBD question, initial treatment was rivastigmine,

Then it got tricky, 5 asked about a tx that might have been given for visual hallucinations and added about this drug making it worse..(i think they meant quetiapine)

6. Anorexia initial intervention

7. Bulimia compared to anorexia

8. Which therapy is shown to be effective for all eating disorders

9. Williams syndrome- disinhibited behaviour

10. Cri du chat - cat like cry

11. Conduct disorder link with maternal smoking

12. Which doen syndrome genetic type linked with high cognitive scores

11. What % autism have epilepsy as a teenager

12.&13&14Critical appraisal questions about study linking bipolar depression with rates of dementia.. one question mentioned why the rates were low at start, another asked about which 2 lines in graph were closely linked most, and another asked how best to describe the overall relationship..

15. Ecg for clozapine patient with high crp

16. Young man overdosed on ssri 2 days earlier in a&e now. Autonomic instability and rigidity.. they were asking was it NMS or SS... looked like serotonin syndrome as onset wad quick, and not leadpipe rigidity

17. Forensic question linking mentally ill people with higher rate of crime than normal population.

18. % chance of child of a female with schizophrenia developing schizophrenia

19. &20 sensitivity and specifity calculation for a new diagnostic test.. the sensitivity was low in 50s or 60s but high specificity of 98%

21. Question about blinding to prevent bias

22. Most common presentation of acute wernickes encephalopathy.. very tricky question,a  all 3 of classic triad, b,c,d = various combinations of 2 of the 3, e = cerebellar/ataxia alone

 

Ps.. as i type this i am realising more errors i made in the exam!!!!

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1)There was a question about imaging in confused patient with pacemaker-CT head

2)schizophrenia in children -13%

3) REM sleep disorder and increased risk of LBD

4) for wernickes I put ophthalmoplegia and ataxia which I think was the answer on SPMM

5) use of melatonin 

6) stop valproate in patient trying to conceive 

7)crossover trial 

 

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Posted (edited)

There was a question on what condition was equal incidence in males and females? Options were unipolar depression, anxiety, hypochondriasis, PTSD. Anyone know the answer to this one?

Edited by anne_w123

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1 hour ago, anne_w123 said:

There was a question on what condition was equal incidence in males and females? Options were unipolar depression, anxiety, hypochondriasis, PTSD. Anyone know the answer to this one?

All of these disorders have higher prevalence in females but I went for Hypochondriasis as others seemed perhaps more common in females. 

1 hour ago, anne_w123 said:

1)There was a question about imaging in confused patient with pacemaker-CT head

2)schizophrenia in children -13%

3) REM sleep disorder and increased risk of LBD

4) for wernickes I put ophthalmoplegia and ataxia which I think was the answer on SPMM

5) use of melatonin 

6) stop valproate in patient trying to conceive 

7)crossover trial 

 

In wernekes, confusion with optholmoplegia is more common presentation than the rest of the options. I put confusion with Ataxia which is wrong. 

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what was the answer for the EMI question where a patient has writes to her therapist that she does not need more therapy and the other was about a man who likes his therapist and goes to the gym. 

 

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1 hour ago, sam asif said:

what was the answer for the EMI question where a patient has writes to her therapist that she does not need more therapy and the other was about a man who likes his therapist and goes to the gym. 

first one was rationalisation and second was positive transference.

please try to recall more questions. if i see the stems then i can recall

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My group have come to the conclusion that we didn’t read ICD enough and the maudsley guidelines . The conduct disorder EMI was just the ICD breakdown , one was dissocial conduct disorder ( the girl who set fires and had few friends one was hyperkinetic conduct disorder for sure , can’t remember the last one . 

The question about MNSv serotonin syndrome was serotonin syndrome because he had overdosed onSSRIs not anti psychotic and hyper reflexive 

what hat to augment Clozapine I think was amisulpuride 

not responding to high dose citapram would first to try another SSRI 

myocarditis with Clozapine stop and refer 

melatonin and promoting sleep duration

autuism and OCD didn’t really know the answer 

 

 

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Also going to the gym because you have the hots for your therapist is sublimation ( there is an episode of the Sopranis where Tony does it . 

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I put sublimation and rationalisation too

i thought aripiprazole would be added to clozapine as it was a patient with weight gain and high cholesterol 

melatonin acts on sleep latency 

serotonin syndrome 

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Also EMI RE precontemplation contemplation and action 

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Any more questions please? 

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3 minutes ago, DrHayat123 said:

Any more questions please? 

Hi, Dr.Hayat, here are some recall questions. My problem is I can recall only if I see a part of the question. Please post whatever you can recall, or if you can add some stems to my questions. New questions have a 40 % chance of repeat.

1.Haloperidol and sertraline OD ,presented with high fever,tachycardia, high BP, muscle rigidity, fluctuation of consciousness, diagnosis
NMS
Serotonin syndrome
2.Why are you scowling at me on disagreements  ? 
Interview technique
clarification
3.You did not mention meeting with manager ? She was excited about the meeting a year ago
Confrontational
4.38 year old gentleman with depression. What antidepressant has no sexual side effects ?
Citalopram
Mirtazapine
5. turning into an exciting opportunity what seemed to be a challenging task
6.Test for executive function in mild cognitive impairment
Clock drawing
Information from informant on activities of daily living
7. ECG changes
Tall peaked T wave 
Abnormal QRS morphology
Pericarditis
Citalopram and QT prolongation
Hypokalemia in vomiting and laxative diarrhoea anorexic girl – U wave
8. common psychiatric disorder after diagnosis of cancer
Adjustment disorder
9. what is true regarding risk assessment 
Historical factors more important than clinical factors
HCR 20 most commonly used
Structured professional judgement more important than clinical judgement
10. regarding predicting repeating offences in antisocial personality disorders
Static factors important
Dynamic factors important
11.your consultant found out some problems in performance and asked you to address problem.which will you do first ?
Audit
Qualitative study
12.stat question about adjusted odds ratios of incidence rate and incidence rate ratio of schizophrenia in ethnic minorities  in south London in population of 100000.   calculate proportion of incidence rate in ethnic minority in population of 800000.
13. which drug cause bladder infection that causes surgical removal of bladder
Ketamine
LSD
14.common age of victims of female perpetrators of homicide
15. new diagnostic test to detect schizophrenia compared with gold standard.400 outpatients in total.16 diagnosed positive by gold standard test and 24 diagnosed positive by new test. 8 patients positive for new test were not diagnosed by gold standard.find
Sensitivity
Specificity
Ppv
16. dysphoric mood,appetite increase,vivid dreams
Amphetamine intoxication
Opiod withdrawal
cocaine
17.where would you send a psychotic sentenced for life for psychotic episode
Locked psychiatry ICU
Medium secure unit
18. Di George Syndrome is associated with Schizophrenia
19. L.D. disorder associated with purine metabolism 
is Lesch Nyhan
phenylketonuria
20. Fishy smell illicit drug is Methadrone

21. Ssri drug and sexual complaint

22.severe Lithium toxicity
nystagmus
23. Lewy body dementia PROBABLE diagnosis feature
Sensitivity to neuroleptics
Dat scan 
24.  NICE criteria for neurosurgery
Intractable OCD
25. What is most common group of murder victim for a psychotic lady?
26. % range for epilepsy rates in an adolescent with autism
27. Alcohol damage to certain part of brain
Cotex
Corpus callosum
Enlarged ventricles
28. Prisoner who shoplifted on remand, what ward to go to when goes manic, unresponsive to medications
29. Stable bipolar lady  who had relapse 2 months ago on valproate and olanzapine...wants to become pregnant via fertility treatment. Next step?
Stop valproate
Stop olanzepine
30. % range of MCI that convert to Alzheimers each year
10 -15
31. Diagnosis of man in 80's with memory problems for 3 yrs and ace3 score 68 who has a son with huntingdons and a deceased sister with alzheimers
32. what to add on an OCD guy who had little response to Sertraline and CBT
33. what to offer a 15 year old who did not respond to CBT for depression and parents not willing for medications or SSRI
IPT
34. what to offer a 28 year old with 10 year history of bulimia nervosa
Specialist referral 
35.what to offer a 21 year old college student of BMI 17 who develop anorexia nervosa 6 months ago
Guided self help
Self help
36. mental capacity
May be absent for 1 task but present in another
37.confidentialiy
Tarasoff case
38. autism children cannot perceive objects as a whole .what is this phenomenon
Hypersystemisation
Theory of mind
Cohesion theory
39. HIV patient with fever headache. multiple Ring enhancing lesions on MRI
Criptococcus neoformans
Tuberculosis
Toxoplasmosis-answer
40. Path analysis (4 questions)
41.Weird questions about school behavior program 
42.gene of schizophrenia HLA*D*****
43.lewy body dementia management (3 questions)
cholinesterase inhibitors
antipsychotics
44.Study re clusters practices – what  sampling to do to avoid trial centre effect in general practices
Cluster sampling
Random sampling
45. in ethnic monorities in south London  the calculation hard enough although there is an spmm example of a similar one a lot of time for half a mark . 
46.Conduct disorder about ICD sub classes
Socialised and unsocialised types
 . Very oddly phrased questions and plenty of marginal calls as in the LB question
47.  Couple more questions about prisoners and what you do in certain examples.... one was to send a collapsed patient to A&E..
48.  another one was a prisoner who murdered someone, and was now becoming completely unmanageable on ward, think it was a secure/locked unit

49.bit of clarification about the mci patoent converting to alzheimers....question was actually quite specific about which type of mci,, Amnesic MCI....i think that means the conversion rate is quite high,>30% compared to mci

50. LBD question, initial treatment was rivastigmine,
Then it got tricky, 5 asked about a tx that might have been given for visual hallucinations and added about this drug making it worse..(i think they meant quetiapine)
51. Anorexia initial intervention
52. Bulimia compared to anorexia
53. Which therapy is shown to be effective for all eating disorders
54. Williams syndrome- disinhibited behaviour
55. Cri du chat - cat like cry
56. Conduct disorder link with maternal smoking
57. Which down syndrome genetic type linked with high cognitive scores
mosaicism
58.Critical appraisal questions about study linking bipolar depression with rates of dementia..
 one question mentioned why the rates were low at start, 
right censor
attrition
delay in entry for diagnosis ?
59.another asked about which 2 lines in ascending survival graph were closely linked most,
60. and another asked how best to describe the overall relationship..
Linear
Not related

61. Ecg for clozapine patient with high crp

62. Young man overdosed on ssri 2 days earlier in a&e now. Autonomic instability and rigidity.. they were asking was it NMS or SS... looked like serotonin syndrome as onset wad quick, and not leadpipe rigidity

63. Forensic question linking mentally ill people with higher rate of crime than normal population.

64. % chance of child of a female with schizophrenia developing schizophrenia

65. &20 sensitivity and specifity calculation for a new diagnostic test.. the sensitivity was low in 50s or 60s but high specificity of 98%

66. Question about blinding to prevent bias

67. Most common presentation of acute wernickes encephalopathy.. very tricky question
,a  all 3 of classic triad,
 b,c,d = various combinations of 2 of the 3, 
e = cerebellar/ataxia alone 
ophthalmoplegia and cerebellar signs

68)There was a question about imaging in confused patient with pacemaker-CT head


69) REM sleep disorder and increased risk of LBD

70) stop valproate in patient trying to conceive 

71)crossover trial
what was the answer for the EMI question
72.DEFENSE mechanisms : where a patient has writes to her therapist that she does not need more therapy so she was absent
rationalisation
73.and the other was about a man who likes his therapist and goes to the gym. Also going to the gym because you have the hots for your therapist is sublimation ( there is an episode of the Sopranis where Tony does it . 
 Positive transference
sublimation
74.There was a question on what condition was equal incidence in males and females? 
Options were unipolar depression
, anxiety
, hypochondriasis,
 PTSD. 
75. The conduct disorder EMI was just the ICD breakdown ,
 one was dissocial conduct disorder ( the girl who set fires and had few friends
 one was socialized conduct disorder for sure , 
76.The question about MNSv serotonin syndrome was serotonin syndrome because he had overdosed onSSRIs not anti psychotic and hyper reflexive 

77.what hat to augment Clozapine I think was amisulpuride 

78.not responding to high dose citapram would first to try another SSRI 

79.myocarditis with Clozapine stop and refer 

80.melatonin and promoting sleep duration

autuism and OCD didn’t really know the answer

81. EMI on precontemplation,contemplation and action 
 

 

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I think there was a question on beneficence and non-maleficence? an EMI question

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There was it’s actually on the mock paper A in spmm ie best decision autonomy paternalism etc 

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