LocumSHO

Paper B - 09 April 2019

14 posts in this topic

How did you find today's paper?

I found it less difficult than the last time I did it. The pass mark will probably be set quite high.

I felt some of the questions were poorly worded, although I was able to work out what the questions were about. One of the EMQ's - I think it was something alone the lines of "Experimental event rate - (minus) control event rate" - I think that was "absolute benefit increase" (if I'm not mistaken).

There was another question on audit cycles, they linked that to the funnel plot, which I wasn't sure why they linked it to the funnel plot (the question describes a scenario where a trainee has been asked to do an audit, they undertake the data collection, analysis, presentation, implementation of changes, and re-audit and then the question asked something along the lines of "which step in the audit cycle is missing from Figure 2?", and I would have thought the question should have asked what step was missing from the scenario described?

There were a few questions on bipolar depression - patient with a history of bipolar disorder, presents with depression, he's not on medication, what would you prescribe. There was another question - I can't quite remember - I think it was about prescribing in pregnancy for a patient with a diagnosis of bipolar affective disorder.

There were a number of questions on patients complaining of symptoms, no pathology found, options including hypochondriacal disorder, factitious disorder, malingering, Munchausen's by proxy, somatisation disorder, etc.

There were questions on the different types of dementia - including Alzheimer's, Binswanger's, Lewy Body Dementia, etc.

Questions on learning disability - Rett's syndrome, Landau-Kleffner's syndrome, etc.

What is the pathology in ADHD?

A new drug is less expensive than the old drug, equal efficacy and safety, how do evaluate the benefit of this one, I think it was cost minimisation analysis.

Please also add any other questions you're able to recall.

 

1 person likes this

Share this post


Link to post
Share on other sites

What about the qualitative study question ? Home care for people with dementia ......? 

‘Was it convenience or purposive sample ?

strength of this study ? 

There was a question about funnel plot and imputed studies and the effect 

a question about forest plot with unpublished studies at the top of the forest plot 

‘question about agomelatin compared to placebo 

5 year old boy with microcephaly and hyperactivity I think the answer is cri du chat 

Williams syndrome most causes are sporadic mutations 

memantin for elderly woman I think the contraindication was GFR <50 

REM behavioral disorder more common in Lewy Body Dementia 

best evidence antipsychotic in Parkinson disease Clozapine ? 

Adult with ADHD I think the best choice was Methylphenidate 

fagan nomogram LR - was 0.5 

‘prevalence 30% then post test probability will be 20% ?

women finished opioid detoxification and her partner is supportive : I think the best choice was Naltrexone 

Antibiotic best avoided in Alcohol dependence metronidazole ? 

Best Roc curve for Alcohol screening : Audit ? CDT? .... 

aquestion about epilepsy ( non epileptic convulsion ) 

baclofen ... in Alcoholism 

 

 

 

 

 

 

 

Share this post


Link to post
Share on other sites

there was a question on drug contra indicated in alcohol ?metronidazole

abstinence after heroin detox - naltrexone and another after alcohol detox-acamprosate 

learning from imitation-social learning

non coningent re inforcement- positive behaviour

question on behaviour phenotype

Assessment for mx of difficult behaviours-Functional analysis

contemplation

symptoms suggestive of wernickes-thiamine                                                                                                                                                                                                    

percentage of psychosis in prisoners

 

question on testamentary capacity

psychological amnesia-for crimes of passion 

MCI conversion rate

 

 

 

clozapine not indicated with h/o paralytic ileus

memantine CI in epilepsy

question on dyslexia

reactive attachment disorder 

 

Share this post


Link to post
Share on other sites
8 hours ago, LocumSHO said:

There was another question on audit cycles, they linked that to the funnel plot, which I wasn't sure why they linked it to the funnel plot (the question describes a scenario where a trainee has been asked to do an audit, they undertake the data collection, analysis, presentation, implementation of changes, and re-audit and then the question asked something along the lines of "which step in the audit cycle is missing from Figure 2?", and I would have thought the question should have asked what step was missing from the scenario described?

Hi LocumSHO, do you know what was the answer for this question? Was it the lack of intervention or the lack of new experimental treatment before re-audit? I was in a dilemma :unsure:

Share this post


Link to post
Share on other sites

Question on antidepressant for severe depression with a previous episode of mania 20 years ago

antipsychotic for psychosis associated for Parkinson disease having best evidence 

Affective PCL item

histiric and clinical HCL items 

key term for solution focussed therapy, DBT

Family therapy questions 

driving time after manic episode

Defense mechanism- displacement?

Calculating specificity- was answer 95% for first question?

Fredreich ataxia, biswanger in emis 

Face validity 

construct validity 

test retest reliability 

I think it was purposive sampling 

Ethical issue study I’m emi- rct?

Kaplan meire curve 

Psychiatric disorder in sle- mania?

Bulimia and anorexia questions 

High heritability in - schizophrenia ?

Suicidal prevalence after self harm?

Ocd same ratio in male: female 

Share this post


Link to post
Share on other sites

Pathological gambling- naltrexone?

Share this post


Link to post
Share on other sites
9 hours ago, Alexis said:

Hi LocumSHO, do you know what was the answer for this question? Was it the lack of intervention or the lack of new experimental treatment before re-audit? I was in a dilemma :unsure:

I don't know what the right answer was. I think I chose the option about the lack of a new hypothesis? (I know the exam was just yesterday, but I've already forgotten which option I selected)...

Overall, though, I think I (mostly) picked the same answers that you guys have noted.

Still, it seems that you guys have recalled the "easy" questions... there were some that were quite difficult... seems we can't recall those questions... LOL...

Anyway, we'll find out in a month's time...

And keep posting whatever you recall...

Share this post


Link to post
Share on other sites

Risk of suicide after deliberate SH - 1 in 100

Narcolepsy- extamcampine hallucinations? Not sure about the answer. Confirm if anyone knows. 

hoover test was answer for some test of legs 

There was a question about pseudo seizures can’t remember that. I chose the last option lol can’t remeber which one was it 

Question about primary prevention of alcohol. All seemed like primary options lol I think that was a tricky one. I chose sensible drinking option. Not sure of it. 

Question about cortical and subcortical dementia. 

One answer was normalisation

Share this post


Link to post
Share on other sites

Partial Defense of mixer 

Share this post


Link to post
Share on other sites

Question about - lady not doing her work and was released from work. She blamed it on people badmouthing her?

Share this post


Link to post
Share on other sites

EMI about forensic scales: HCR-20 and PCL-R (Affective, historical and clinical) 

Possible answers: Personality disorder, Psychopathy, Impulsivity etc

Share this post


Link to post
Share on other sites

Also - empty chair technique - gestalt

IPT - brief psychotherapy  session

question on patient stopped paroxetine, now coming back with anxiety agitation etc

 

 

Share this post


Link to post
Share on other sites

Interview child with PTSD

? Not ask about trauma directly unless disclosed by child.

Share this post


Link to post
Share on other sites

I'll try to summarize the ques posted before & add in some that I remember:

MCQ

1. Drug contraindicated in alcohol: Metronidazole

2. Percentage of antisocial personality disorder in prisoners

3. Which is not part of testamentary capacity?

4. Psychological amnesia: for crimes of passion 

5. A man complaining of left hand weakness. Tests come back negative. How to test if someone is suffering from functional cause? Hoover's test

6. Annual conversion rate of MCI to other forms of dementia: 5-10% / 15-20% / 30-40%

7. Man with schizoaffective disorder previously adequately treated with Clozapine, but he recently had epileptic seizure. His Clozapine level is at the upper end of therapeutic range. What's the next step? Options: Stop Clozapine / Reduce Clozapine dose / Add Valproate

8. A 40+ year old man currently in depressive phase, but has history of mania ~ years ago. What's the best tx? Lithium / Valproate / Quetiapine / Lamotrigine

9. Clozapine not indicated as outpatient initiation for patient with? Options: DM / Hypertension / H/o paralytic ileus

10. Memantine contraindicated in? Options: eGFR 51ml/min/1.73m2 / Epilepsy / H/o myocardial infarction / HR 55bpm

11. 5 year old boy with severe learning disability, microcephaly, noisy & hypertelorism. Options: Cri-du-chat / Williams / Angelman

12. Which of the following is true about Williams syndrome? Options: Most causes are sporadic mutations / It's caused by mutation in chromosome 22 / It causes severe learning disability

13. REM behavioral disorder: More common in Lewy Body Dementia 

14. Antipsychotic with best evidence base for initial use in Parkinson disease: Clozapine? (Quetiapine was one of the options too. The word "initial use" got me in dilemma actually) 

15. 35-year-old man diagnosed as ADHD with moderate functional impairment. What's the best treatment? Options: Methylphenidate / Atomoxetine / Clonidine

16. Which of the following has the best ROC for alcohol screening? Options: AUDIT / CDT / GGT / MCV

17. Which of the following is true about non-epileptic convulsion? Options: 1/10 patients in specialist service have non-epileptic convulsion / 90% are women / Usually no urinary incontinence / May have preceding epileptic seizure in the past

18-20. Referring to the Fagan nomogram given, prevalence of an illness is 10%. Positive LR was 2 while negative LR was 0.5. 

- If a person was screened negative, what's the probability he has the illness?

- Same ques as above, but prevalence changed to 30% instead of 10%.

- What contributed to the difference of probability in the example above?

Options: PPV & NPV has changed / PPV is heavily dependent on prevalence / Sensitivity & specificity have changed.

21-24. Excerpt about wanting to find out about old people in nursing home's sleep. Interview was done & electronic questionnaires were distributed to the carers. 

- What was the aim of the study? 

- What was the sampling method? (Options: Convenience / Purposive / etc) 

- What was the strength of the study? 

- What can be inferred from the result?

25-27. Funnel plot (assymetrical with missing dots near the broader end). 

- What was missing in the above data? (Options: Big studies with negative result / Big studies with positive result / Small studies with negative result / Small studies with positive result)

- By filling up the missing area with new plots, what happened to the result? (Options: It is more representative of true finding / It underestimates the effect size / It overestimates the effect size)

- What was the bias causing the asymmetry: Publication bias.

28-29. Forest plot with unpublished result & published result and a total effect regarding comparison of Agomelatine vs placebo.

- What can be inferred from the data?

- What was the strength of the study: Including unpublished results.

30. A trainee has been asked to do an audit on their clinical practice. So he collected the data, presented his finding in the meeting. 8 weeks later, he re-audit again. What's missing from his audit? Options: Lack of intervention / Lack of new treatment option to improve the problem

31. What is the pathology in ADHD?

32. A new drug is found to have equal efficacy and safety with an old drug. How to evaluate the benefit of this one? I think it was cost minimisation analysis.

33. You're interviewing a child with PTSD secondary to child abuse. What's the approach for his other siblings?

Options: Not to ask about trauma directly unless disclosed by child / Have session with the siblings without the abuser (forgot other options)

34. A patient was previously on Paroxetine but stopped taking it abruptly for few days. He's now back with anxiety & agitation. What's the likely step?

Options: Start another antidepressant (forgot the drug given) / Restart Paroxetine and taper off slowly

35. "Empty chair" is associated with which psychotherapy? Answer: Gestalt therapy

36. A lady who was always neglecting her responsibilities at work and not cooperative with her colleagues was recently made redundant from work. She said it's because of her colleagues badmouthing about her rather than admitting her mistake. Options: Rationalization / Denial / Reaction formation / Displacement / etc

37. Risk of suicide after deliberate self-harm: 1 in 100

38. Narcolepsy is associated with which of the following? Options: Extracampine hallucinations / Myoclonic jerks / etc

39. Which is the most effective primary prevention of alcoholism? Options: Promote sensible drinking / Increasing the price of alcohol / etc

40. Treatment option for pathological gambling: Naltrexone? (unsure of answer)

41. Patient just recovered from manic episode. How long should he wait before he can drive again? Options: 1 month / 3 months / 6 months / 1 year / etc

42. The ability of a questionnaire to measure what it sets out to measure. What type of validity is this?

43. Something on test-retest reliability

44. Calculating specificity

45-46. Kaplan-Meier curve showing probability of not developing depression with time among smokers & non-smokers.

- What does the y-axis in the graph represent? (Answer: Probability of not developing depression)

- What conclusion can be drawn from the graph? (One of the options was, by 10 years, 95% of the non-smokers develop depression. Don't fall for the trick! Remember that the y-axis is actually the probability of NOT developing depression)

47. Common psychiatric disorder in SLE: Mania? (unsure)

48. Question on bulimia & anorexia

49. High heritability in: Schizophrenia? (unsure)

 

EMI

1. Abstinence after successful heroin detox with a supportive partner: Naltrexone

2. Completed alcohol detox 2 weeks ago & currently having craving. Pt wants to prevent relapse: Acamprosate 

3. A lady chronic alcohol user currently presenting with confusion, ophthalmoplegia. Tx: Thiamine

4. Learning from imitation: Social learning

5. Encouragement by giving reinforcement unrelated to the desired behaviour: ?non contingent reinforcement

6. Assessment for mx of difficult behaviours: Functional analysis

7. Mother complains child having haematuria. Upon urinalysis, found red food colouring instead of blood in urine: Munchausen by proxy

8. Man been investigated for colon cancer but negative findings. He still insists having colon cancer, and now claims that he can't work anymore because of it. ? Factitious ?malingering?

9. Lady been investigated for illness many times but all negative findings. She insists doctors are missing something. Hypochondriasis

10. A young man just underwent rhinoplasty but now claims he's nose is even more malformed. Body dysmorphic disorder

11. A 6-year-old girl referred for repetitive hand movements starts losing ability to speak. ?Rett's

12. An 8-year-old boy is unable to interact well with his peers in school as he couldn't understand the conversations especially if the classroom is noisy. Once he understands instructions and knows what's expected from him, he's able to perform well. ?Normal development

13. An adopted girl's foster mother is concerned that she doesn't attach to her, but would start crying when she's put in the crib. ?Reactive attachment disorder

14. "Experimental event rate - (minus) control event rate": Absolute benefit increase

15. 1 / ABI = NNT

16. Questions on learning disability - Rett's syndrome, Landau-Kleffner's syndrome, etc.

17. A lady currently in 1st trimester of pregnancy having 1st episode mania. What's suitable tx? (Options: Fluoxetine / all types of anticonvulsants / the only choice of antipsychotic in the list was Haloperidol)

18. There were questions on the different types of dementia - including Alzheimer's, Binswanger's, Lewy Body Dementia, etc.

19-21. 3 questions on PCL-R: What is the History / Clinical / Affective component? (Options: Psychopathy / impulsivity / Needing activity to kill boredom / etc)

22-23. Key term for solution focused therapy & DBT

24-26. Types of family therapy

27. Fredreich ataxia, biswanger

 

Thanks to all the sharing here, we managed to get up to 76 recall questions LOL! That's like half of the exam :lol: Hope we all passed the exam, fingers crossed! Good luck everyone!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now