psychiatry2014

Paper B April 2018 Feedbaback

32 posts in this topic

On 4/16/2018 at 12:57, Nahid Hakim said:

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 
 

 

Thank you for posting so many questions and sorry for delayed response. I must say you have got a brill memory. I am still struggling to remember anything in addition to your 81 questions. Shall we discuss the difficult ones with their answers? 

1. Augmenting Clozapine, like you, I also marked Amisulpride, but I am not sure if its the right answer coz the patient had weight gain and dyslipidemia, and Aripiprazole seems more reasonable but again there is more evidence for amisulpiride (if weight gain is not an issue?)

2. Equal incidence, very tricky one, coz all of them have increased incidence in females, I put hyperchondriasis?

3. Wernekes, again I made a mistake, I put ataxia and confusion, correct answer is confusion and optholmoplegia

4. autism children cannot perceive objects as a whole .what is this phenomenon.....Hypersystemisation

5. Haloperidol and sertraline OD, Serotonin syndrome, coz onset's quite acute

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Hi, Dr. Hayat,

1.clozapine should be augmented by amisulpride (according to evidence base)

2.wernickes-

answer is cerebellar signs and opthalmoplegia, because commonly presented signs

3.autistic children not being to perceive things as a whole

answer maybe cohesion theory,but certainly not hypersystemization,because it is ability to perceive repeating patterns in things, eg. music,seen in high functioning autistic children.

4.haloperidol and sertraline OD, answer is NMS, because of cardinal signs fever and rigidity

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central coherence theory (CC), suggests that a specific perceptual-cognitive style, loosely described as a limited ability to understand context or to "see the big picture", underlies the central disturbance in autism and related autism spectrum disorders

apologies for my fragmented memory, but was there any mention of myoclonus or hyperreflexia. these are 2 main features present in Serotonin and not NMS. if these are mentioned then it is definitely serotonin. i chose NMS because of onset of symptoms within 48 hours and increased temperature and rigidity.

amisulpiride is the answer in mock paper B

cerebellar signs and ophthalmoplegia is also in mock paper B

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WE is characterized by the triad of altered mental status, 
ataxia, and ophthalmoplegia, but only 16% of patients present 
with the full classic triad of symptoms [5]. Mental status 
changes are the most frequent findings in these patients 
(82%), followed by ocular findings (29%) and ataxia (23%)

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I think there was hyperreflexia so I put serotonin syndrome. You can also get high temp with that.

the mock b paper says amisulpiride is best to augment with clozapine if poor treatment response but the exam asked what would be best when associated with weight gain and high cholesterol which is why I put aripiprazole 

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Yes.

Seems that the Mock question was slightly different than the exam question, and hence Aripiprazole seems to be the best answer

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Hi guys. Does any one have any questions from April 2018 exam?

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