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EMIs from Autumn 2006

12 posts in this topic

Can anybody clear this problem

http://www.psychclub.com/YaBB.pl?num=1156996276/19#19

http://www.psychclub.com/YaBB.pl?num=1172989877/1#1

Lad writes:

1. EEG CHANGES

A. Normal EEG

B. Reduced beta rhythm

C. Increased beta rhythm

D. Paroxysmal frontal lobe discharge

E. Spikes and waves

F. Generalised slowing with conserved alpha rhythm frontally.

G. Triphasic waves

1. An 80 old widower, miserable, not sleeping or eating, appears depressed (2 options) A,C

2. A 75 year old woman, gradually more forgetful over the past 2 years (2 options) F,B

3. A 70 year old man, with disinhibition, change in personality, mild memory impairment (2 options) C,E

Grandy writes:

A. Normal EEG

B. Reduced beta rhythm

C. Increased beta rhythm

D. Paroxysmal frontal lobe discharge

E. Spikes and waves

F. Generalised slowing with conserved alpha rhythm frontally.

G. Triphasic waves

1. An 80 old widower, miserable, not sleeping or eating, appears depressed (2 options)

2. A 75 year old woman, gradually more forgetful over the past 2 years (2 options)

3. A 70 year old man, with disinhibition, change in personality, mild memory impairment (2 options)

1 AC

2 FC

3DF

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Here is my solution for this.:

EMI 1

EEG CHANGES

A. Normal EEG

B. Reduced beta rhythm

C. Increased beta rhythm

D. Paroxysmal frontal lobe discharge

E. Spikes and waves

F. Generalised slowing with conserved alpha rhythm frontally

G. Triphasic waves

1. An 80 old widower, miserable, not sleeping or eating, appears depressed (Choose Two)

A. Normal EEG

C. Increased beta rhythm

http://www.psychclub.com/YaBB.pl?num=1156996276/19#19

http://www.psychclub.com/YaBB.pl?num=1172989877/1#1

2. A 75 year old woman, gradually more forgetful over the past 2 years (Choose Two)

B. Reduced beta rhythm

D. Paroxysmal frontal lobe discharge

http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote 'The electrophysiological correlate of polymyoclonus that can be seen in AD and other pathological states is a bifrontal negativity in the EEG that precedes the myoclonic jerk. This new type of electrophysiological correlate of myoclonus may reflect activity of a subcortical generator'.

3. A 70 year old man, with disinhibition, change in personality, mild memory impairment (Choose Two)

B. Reduced beta rhythm

F. Generalised slowing with conserved alpha rhythm frontally

http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote 'Because the anterior cholinergic system is relatively preserved in Pick disease, the EEG changes are not prominent frontally.'.

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Here is my solution for this.:

EMI 1

EEG CHANGES

A. Normal EEG

B. Reduced beta rhythm

C. Increased beta rhythm

D. Paroxysmal frontal lobe discharge

E. Spikes and waves

F. Generalised slowing with conserved alpha rhythm frontally

G. Triphasic waves

1. An 80 old widower, miserable, not sleeping or eating, appears depressed (Choose Two)

A. Normal EEG

C. Increased beta rhythm

http://www.psychclub.com/YaBB.pl?num=1156996276/19#19

http://www.psychclub.com/YaBB.pl?num=1172989877/1#1

2. A 75 year old woman, gradually more forgetful over the past 2 years (Choose Two)

B. Reduced beta rhythm

D. Paroxysmal frontal lobe discharge

http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote 'The electrophysiological correlate of polymyoclonus that can be seen in AD and other pathological states is a bifrontal negativity in the EEG that precedes the myoclonic jerk. This new type of electrophysiological correlate of myoclonus may reflect activity of a subcortical generator'.

3. A 70 year old man, with disinhibition, change in personality, mild memory impairment (Choose Two)

B. Reduced beta rhythm

F. Generalised slowing with conserved alpha rhythm frontally

http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote 'Because the anterior cholinergic system is relatively preserved in Pick disease, the EEG changes are not prominent frontally.'.

My answer

Q1 A, C

Q2 B, D

Q3 B ?

I am not very convinced about F because Ref http://www.emedicine.com/neuro/topic109.htm

Quote(Posterior alpha rhythm is more preserved)

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Still confused about above.

Can anybody suggest solution to these questions. Especially the first two.

Thanks

Kamran

GROUP THERAPY

A. Sub-grouping

B. Pairing

C. Interpretation

D. Universality

E. Counterdependence

F. Dependence

G. Free floating discussion

1. Two characteristics of a psychodynamic opientated group

2. Two features that improve outcome in group therapy

3. Two features that pose a problem in group therapy

7. DEMENTIA FEATURES

A. Presenillin mutations

B. Tau mutations

C. Amyloid plaques

D. Lewy bodies

E. Apo E e4

F. A-synuclein inclusions

G. Mamillary body lesions

1. Lady in her 50s with dementia (two options)

2. Gentleman in his 80s with gradually progressing dementia over the last year. History of alcohol abuse for 20 years. He had a fall and a concussion 5 years ago (two options)

3. Gentleman in his 60s. Progressive cognitive decline with visual hallucinations and variable confusion

8. STATISTICS (can't really remember-it did not make sense to me in the first place anyway)

A survey that tries to ascertain the prevalence of hyperkinetic disorder is been done. Height and sex are also recorded. 20 years later the same population is being screened for antisocial personality disorder. Height is normally distributed in the population.

A. t-test

B. t-paired test

C. Mann-Whitney test

D. Chi square test

E. Cluster analysis +++

1. three simple tests to see if there is an association between height and hyperkinetic disorder

2. two simple tests to see if there is an association between sex and hypekinetic disorder

3. two tests to see if height and sex have an association with subsequent development of antisocial personality disorder in patients with hyperkinetic disorder

SET 2

EMI

EEG CHANGES(2S04:2S05)

1)Normal EEG

2)Alpha rhythm

3)Reduced beta

4)Increased beta

5)Focal Frontal lobe discharge

6)Spikes and wave

7) Conserved alpha waves in the posterior regions, inthe background of generalised slowing

8)Triphasic wave

Lead in : Which of the above EEG would you be most likely to expect in association with these clinical scenarios

Scenarios:

1= An 80 old widower, who has got more miserable and is not sleeping or eating and appears depressed.(Choose 2)

2= A 75 year old woman who has got more forgetful over the past 9 months,loosing her way.(Choose 2)

3=A 70 year old man who has 2 year history ofspeech difficulties,episodic aggressive behaviour and has started shoplifting, mild cognitive decline.(Choose1)

Drugs Adverse Effects(2SO5;2AO5)

Options

Cardiomayopathy

Diabetes Insipidus

Diabetes Mellitus

Lithium Toxicity

Hypothroidism

Neuroleptic Malignant Syndrome

Pulmonary Embolism

Select one most likely adverse effect in the following presentations.

1= A 24 year old man who has been stable on clozapine for 2 years comes to your clinic with letaergy, breathlessness, and palpitations

2= A lady stable on Lithium for 2 years comes to see you with polyuria, ploydipsia, and lethargy.She looks dehydrated and has high sodium.

3= A young man started recently on Risperidone. He is found in the ward febrile with labile blood pressure, increased muscle tone ,sweating and confusion.

SET 3

Medication

A. Atomoxetine

B. Methylphenidate

C. Melatonin

D. Fluoxetine

E. Diazepam

F. Clonidine

G. Carbamazepine

H. Sodium Valproate

1. A child with pervasive hyperactivity at school and home. Fidgety, hyperactive and poor attention (three)

2. Child with low mood, insomnia, loss of weight and loss of interest in the surroundings (one)

3. 3 year old child with mild learning disability, now presenting with intractable insomnia persisting even after behavioural intervention (two)

Obsessive compulsive Disorder

Options

A. Fluoxetine

B. Desipramine

C. Risperidone

D. Quetiapine

E. Sertraline

F. Lamotrigine

G. Reboxetine

H. Lithium

1) A 13 year old child who has a 5 year history of depression. He has been found depressed in the past 6 months (one)

2) A 30 year old man with severe OCD has been on 2 different antidepressants. What would you suggest as an add on to his medication (two)

3) A 25 year old man with OCD. Which anti-depressants are not helpful (two)

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http://www.mrcpsychrevisionwiki.org/wiki/index.php?title=Paper_3_EMIs_2006#EMIs_from_Autumn_2006

EMIs from Autumn 2006

EMI 1

EEG CHANGES

A. Normal EEG

B. Reduced beta rhythm

C. Increased beta rhythm

D. Paroxysmal frontal lobe discharge

E. Spikes and waves

F. Generalised slowing with conserved alpha rhythm frontally

G. Triphasic waves

1. An 80 old widower, miserable, not sleeping or eating, appears depressed (Choose Two)

A. Normal EEG

C. Increased beta rhythm

http://www.psychclub.com/YaBB.pl?num=1156996276/19#19

http://www.psychclub.com/YaBB.pl?num=1172989877/1#1

2. A 75 year old woman, gradually more forgetful over the past 2 years (Choose Two)

B. Reduced Beta Rhythm

D. Paroxysmal frontal lobe discharge

http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote 'The electrophysiological correlate of polymyoclonus that can be seen in AD and other pathological states is a bifrontal negativity in the EEG that precedes the myoclonic jerk. This new type of electrophysiological correlate of myoclonus may reflect activity of a subcortical generator'.

3. A 70 year old man, with disinhibition, change in personality, mild memory impairment (Choose Two)

B. Reduced beta rhythm

F. Generalised slowing with conserved alpha rhythm frontally

http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote 'Because the anterior cholinergic system is relatively preserved in Pick disease, the EEG changes are not prominent frontally.'

EMI 2

SIDE EFFECTS FROM MEDICATION

A. Cardiomyopathy

B. Diabetes Insipidus

C. Diabetes Mellitus

D. Lithium Toxicity

E. Hypothyroidism

F. Neuroleptic Malignant Syndrome

G. Pulmonary Embolism

1. Young man, stable on clozapine for 2 years complains for breathlessness, lethargy and palpitations (one option)

A. Cardiomyopathy

2. Female stable on Lithium for 2 years presents with polyuria and polydipsia. She looks confused, dehydrated and has high sodium levels (one option)

D. Lithium Toxicity

3. Young man started recently on Risperidone. He is found on the ward febrile with labile blood pressure, increased muscle tone, sweating and confusion (one option)

F. Neuroleptic Malignant Syndrome

EMI 3

OBSESSIVE COMPULSIVE DISORDER

A. Fluoxetine

B. Desipramine

C. Risperidone

D. Quetiapine

E. Sertraline

F. Lamotrigine

G. Reboxetine

H. Citalopram

J. Escitalopram

K. Lithium

1. A 15 year old child who has a 5 year history of OCD. He has been found depressed in the past 6 months (one option)

A. Fluoxetine

2. A 30 year old man with severe OCD has been on 2 different antiobsessional medications without a significant benefit. What would you suggest as an add-on treatment (two options)

C,K

3. A 25 year old man with OCD. Which anti-depressants are not helpful (two options)

B, G

http://www.psychclub.com/YaBB.pl?num=1172989877/11#11

EMI 4

MEDICATION IN CHILDREN

A. Atomoxetine

B. Methylphenidate

C. Melatonin

D. Fluoxetine

E. Diazepam

F. Clonidine

G. Carbamazepine

H. Sodium Valproate

1. A child with pervasive hyperactivity at school and home. Fidgety, hyperactive and poor attention (three options)

Methylphenidate, Clonidine and Atomoxetine

2. Child with low mood, insomnia, loss of weight and loss of interest (one option)

Fluoxetine

3. 3 year old child with mild learning disability, now presenting with intractable insomnia persisting even after behavioural intervention (two options)

Melatonin and Diazepam

EMI 5

GROUP THERAPY

A. Sub-grouping

B. Pairing

C. Interpretation

D. Universality

E. Counterdependence

F. Dependence

G. Free floating discussion

1. Two characteristics of a psychodynamic orientated group

Free floating discussion

Pairing

2. Two features that improve outcome in group therapy

Interpretation and Universality

3. Two features that pose a problem in group therapy

A. Sub-grouping

F. Dependence

http://books.google.com/books?id=PxwDqN2RaxMC&pg=PA63&lpg=PA63&dq=group+therapy+subgrouping&source=web&ots=SAR8ReWjex&sig=3-1LFwg0ZOOZQId_XckZm_MyH64#PPA65,M1

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EMI 6

DEMENTIA FEATURES

A. Presenillin mutations

B. Tau mutations

C. Amyloid plaques

D. Lewy bodies

E. Apo E e4

F. A-synuclein inclusions

G. Mamillary body lesions

1. Lady in her 50s with dementia (two options)

A,C

2. Gentleman in his 80s with gradually progressing dementia over the last year. History of alcohol abuse for 20 years. He had a fall and a concussion 5 years ago (two options)

E,G

3. Gentleman in his 60s. Progressive cognitive decline with visual hallucinations and variable confusion

D. Lewy bodies

EMI 7

STATISTICS (can't really remember-it did not make sense to me in the first place anyway)

A survey that tries to ascertain the prevalence of hyperkinetic disorder is been done. Height and sex are also recorded. 20 years later the same population is being screened for antisocial personality disorder. Height is normally distributed in the population.

A. t-test

B. t-paired test

C. Mann-Whitney test

D. Chi square test

E. Cluster analysis

1. Three simple tests to see if there is an association between height and hyperkinetic disorder.

A. T-test, B. Paired T-test, D. Chi square test

2. Two simple tests to see if there is an association between sex and hypekinetic disorder

C. Mann-Whitney test, D. Chi square test

3. Two tests to see if height and sex have an association with subsequent development of antisocial personality disorder in patients with hyperkinetic disorder

E. Cluster analysis

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EMI 2  

SIDE EFFECTS FROM MEDICATION  

A. Cardiomyopathy  

B. Diabetes Insipidus  

C. Diabetes Mellitus  

D. Lithium Toxicity  

E. Hypothyroidism  

F. Neuroleptic Malignant Syndrome  

G. Pulmonary Embolism  

1. Young man, stable on clozapine for 2 years complains for breathlessness, lethargy and palpitations (one option)  

A. Cardiomyopathy  

2. Female stable on Lithium for 2 years presents with polyuria and polydipsia. She looks confused, dehydrated and has high sodium levels (one option)  

[highlight]D. Lithium Toxicity  [/highlight]

Would have said diabetes insipidus but agree with the other two

3. Young man started recently on Risperidone. He is found on the ward febrile with labile blood pressure, increased muscle tone, sweating and confusion (one option)  

F. Neuroleptic Malignant Syndrome  

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1. A 15 year old child who has a 5 year history of OCD. He has been found depressed in the past 6 months (one option)

A. Fluoxetine

I think Sertraline and not Fluoxetine, has a license in this age group and therefore the better answer.

what do you think?

Good job, Kamran

2. A 30 year old man with severe OCD has been on 2 different antiobsessional medications without a significant benefit. What would you suggest as an add-on treatment (two options)

C,K

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Kamran -

For LBD you need to add alpha-synuclein to your answers i.e

3. Gentleman in his 60s. Progressive cognitive decline with visual hallucinations and variable confusion &nbsp:lol:, F

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GROUP THERAPY

A. Sub-grouping - where some members of a group split off

B. Pairing - BAD! (Bion) A bit like sub-grouping, in pairs!

C. Interpretation - offer tentatovely in psychodynamic psychotherapy

D. Universality - Yalaom's 11 therapeutic factors

E. Counterdependence - narcissists don't wish to be dependent so they go totally overboard in the opposite direction

F. Dependence - BION

G. Free floating discussion - psychodynamic : taking an interest in another person's narrative

1. Two characteristics of a psychodynamic orientated group

FREE FLOATING DISCUSSION and INTERPRETATION

2. Two features that improve outcome in group therapy

UNIVERSALITY and ? FREE FLOATINg DISCUSSION

3. Two features that pose a problem in group therapy

PAIRING and DEPENDENCE

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I think 2 may be universality and sub-grouping, F_S

Sub-groups can be used by the conductor to resolve underlying conflicts. Sub-grouping is not just about splitting off, but about people sharing experiences and finding themselves similar to others.

In fact, Agazarian's system centred therapy encourages 'functional sub-grouping' as one of the aims of creating as effective a therapeutic group as possible.

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